Professional Documents
Culture Documents
in the Practice
of Psychotherapy
Clinical Implications of A M Theories
Robert Plutchik
Preface ....................................................... xi
Introduction .................................................. 3
Chapter 1. Emotions in Our Lives ........................... 11
Chapter 2 . Symptoms and Emotions .......................... 21
Chapter 3. Theories of Emotion ............................. 39
Chapter 4. A Psychoevolutionary Theory of Emotion .......... 59
Chapter 5. Emotions and Personality Disorders ................ 81
Chapter 6. Emotions, Deception. Ego Defenses. and
Coping Styles..................................... 107
Chapter 7. Therapist Tactics for Uncovering Emotions ......... 127
Chapter 8. Psychotherapy and Existential Issues ............... 139
Chapter 9. Therapeutic Communication ...................... 149
Epilogue ...................................................... 169
Appendix: Measurement Implications of Affect Theory ........... 171
References .................................................... 203
Author Index ................................................. 217
Subject Index ................................................. 221
About the Author ............................................ 229
ix
PREFACE
Early in my life I learned that all people use their emotions in varying
ways to help them deal with lifes problems. I discovered that smiles and
laughter went a long way toward enhancing relationships among friends,
family members, students, and colleagues. I also saw that when people
became angry they sometimes got their way, and that when they looked
sad, others often tried to be nice to them. I discovered that falling in love
felt good and that being abandoned felt terrible. When I eventually had
children of my own, I was thrilled with the experiences of their growth
and development and anguished when problems befell them.
After getting an undergraduate degree in physics and a graduate de-
gree in experimental and physiological psychology, I eventually found my-
self doing research on emotion. This research was primed during a period
of primate brain research at the National Institute of Mental Health where
our research group was examining the effects of electrical brain stimulation
on emotional and motivational behavior. Later studies of manic-depressive
illness at the Psychiatric Institute in New York City led me into clinical
research in psychiatric hospitals and finally to a plethora of studies at the
Albert Einstein College of Medicine, where I spent 25 interesting and
stimulating years.
During my research, I came to realize that the study of emotions
should involve at least three broad facets. One facet is concerned with
defining the concept of emotion, showing its relations to other ideas and
areas of study, and stimulating the gathering of new knowledge. The second
facet should be concerned with issues of emotion measurement and con-
cepts related to emotion (e.g., attachment, stress, and personality). The
third facet should be concerned with what to do when our emotions create
problems for us-in other words, the area of emmional dysfunction and
change.
In my previous writings on emotion I have tried to deal primarily
xi
with the first two facets. I have developed a theory of emotion, which I
call a psychoevolutionary theory because I believe that emotions are relevant
to all living organisms and have highly adaptive purposes. I have tried to
show that emotions communicate information and intentions from one
individual to another, regulate social interactions, and increase the chances
of survival in the face of lifes adversities. I have also tried to show that
emotions are systematically related to other areas of research usually con-
sidered as quite separate from basic research on emotions. These other areas
include the study of personality, personality disorders and other mental
disorders, ego defenses, and coping styles, to name a few. Over the years I
have also tried to develop appropriate and theory-based ways to measure
emotions and the concepts derived from them. Both of these facets are
considered to some degree in this book.
However, in the present volume, I have tackled the third facet of
affect theory in more depth: its relevance to problems of emotional dis-
orders and to the treatment of these disorders. In this book I examine the
relations between emotions and symptoms of emotional disorders. I review
current affect theories that have particular relevance to clinical work, and
I examine how emotions may be related to personality disorders. I have
selected personality disorders (or Axis I1 disorders) because there are good
theoretical reasons, to be described later, for considering personality dis-
orders to be extreme derivatives of personality traits, which in turn, are
derived from emotions.
A number of examples are taken from psychodynamic psychotherapy
not because I believe it to be the most effective form of therapy but because
it is one form of effective psychotherapy that I have studied in my research
and clinical work. Much of what I present has clear relevance for other
forms of therapy, such as cognitive-behavioral therapy and family therapy,
because all deal fundamentally with emotions.
Two central issues described here are therapist tactics used for uncov-
ering emotions and the complex problems of therapeutic communication.
Although many ideas reflect psychodynamic theory, uncovering emotions
and communicating therapeutically are central to all forms of effective
treatment. I also include a discussion of tests and scales used to measure
emotions and related concepts. I hope that this presentation serves as an
impetus to further research that focuses on emotions and their importance
in the psychotherapeutic enterprise.
There is both theory and practice in the following pages. I hope that
the material presented is useful to clinicians, to students planning to be
clinicians, and to those who are interested in research on psychotherapy.
Above all, I would like to emphasize that the ideas presented in the fol-
lowing pages do not represent another school of therapy. It is time we
reduced the list of therapeutic schools rather than increased them. Perhaps
xii PREFACE
the recognition of emotions as a central aspect of the therapeutic process
will help bring this about.
It is difficult to appropriately express my indebtedness to others in
connection with the writing of this book. Some influences are clearly ev-
ident, whereas others are subtle and possibly hidden in the recesses of my
consciousness. I have gotten ideas from colleagues, books, and clients, and
it is now impossible to clearly disentangle the labyrinth of sources. They
have become fused, like the colors of a portrait or the notes of a fugue.
However, I would like to thank a few people who have contributed
to my thinking. Byram Karasu, chairman of the Psychiatry Department at
the Albert Einstein College of Medicine, has sensitized me to the nuances
of therapeutic communication, and Henry Kellerman has broadened my
knowledge of the subtleties of expression of defense mechanisms. I would
also like to express my sincere appreciation to my good friend, Carlos
Climent (at the University of Cali, Colombia), and my daughter, Lori
Plutchik, both psychiatrists, who have given me the benefit of their ex-
pertise and suggestions.
A number of people have read all of the manuscript and have con-
tributed in many ways to its final preparation. Margaret Schlegel, devel-
opment editor at the Books Program of the American Psychological As-
sociation, provided detailed and illuminating comments about all aspects
of the manuscript; I am grateful to her. Finally, I would like to express my
deepest appreciation to my wife, Anita, for her continuing emotional sup-
port as well as her acute insights, which often helped me avoid ambiguities
of expression and thought.
PREFACE xiii
Emotions
in the Practice
of Psychotherapy
INTRODUCTION
3
Because of the universal relevance of emotions to life as well as to
psychotherapy, I sometimes had difficulty in deciding on which issues to
focus. I finally decided to include chapters that deal with different aspects
of emotion in which I felt I could make a special contribution. The ma-
terial in the book is a hybrid of empirical research, theoretical models, and
clinical experience. Four ideas are the driving forces behind the develop-
ment of this book: (a) emotions are of central importance in the process
of psychotherapy, (b) ambiguities exist in our conceptions of emotions, (c)
few systematic theories of emotion are of wide relevance to clinical prob-
lems, and (d) the implications for therapy of systematic theories of emo-
tions must be made explicit. To give readers a preliminary sense of this
content, I present a brief description of each chapter.
There are many reasons for the confusion and diversity in theorizing
about emotions. One is that people learn to censor and inhibit the ex-
pression of their feelings and assume that other people do also. Others
learn to exaggerate their emotions and to use this exaggeration to gain
important resources that they do not know how to obtain otherwise. This
means that subjective reports of emotion cannot be taken at face value.
Another reason is the impact of the philosophy of behaviorism, which
posits that inner states cannot be reliably observed and are therefore out-
side the realm of scientific psychology. A third major reason is the diversity
of historical traditions concerned with emotions. These traditions range
from Darwins (1872/1965) evolutionary approach to emotions, to William
Jamess ( 1884) psychophysiological viewpoint, to the Freudian psychody-
namic tradition (S. Freud & J. Breuer, 1895/1936) , and the more recent
cognitive tradition (e.g., Heider, 1958). These traditions have focused on
different aspects of the complex state called an emotion.
The remainder of the chapter reviews a number of clinically relevant
theories of emotion. Although all clinicians write about emotions to some
degree, I chose those authors who have specifically tried to develop general
approaches to affect as applied to clinical practice. The result is that I have
included a number of psychoanalytic theories (represented by Brenner,
1974; Freud, 1926/1959; Rado, 1975; and Spezzano, 1993), Tomkinss
(1962) theory of affects as the primary motivational system, Vaillants
(1997) theory of affect restructuring, Richard Lazaruss (e.g., 1991) theory
INTRODUCTION 5
of core relational themes, and Greenbergs (Greenberg & Paivio, 1997)
theory of emotional schemes. All of these authors recognize that emotions
are attempts to adapt to challenging aspects of ones environments, that
emotions are not always available to introspection, and that emotions are
related to the meanings people give to events.
Various tactics and strategies are described that clinicians may use to
understand emotions, encourage the appropriate expression of emotions,
and manage emotions outside of the therapy session when they appear.
Examples of such tactics are identifying precisely the stimuli that trigger
emotions, identifying the basic emotion components that underlie each
emotion, and examining impulses to action. I discuss 16 primary tactics
INTRODUCTlON 7
and additional therapist interventions for uncovering and managing emo-
tions.
INTRODUCTION 9
blame, help-seeking, minimization, and reversal. A number of studies are
described that have used this test. Relations have been obtained between
coping styles and interpersonal problems, suicide risk, rehospitalization, al-
coholism, business management styles, and parenting styles. Copies of each
of these tests are included. I hope that students, experienced researchers,
and clinicians find these instruments of value in their work.
CONCLUSION
Most importantly, I hope that the readers of this book are receptive
to my attempt to relate emotion theory, therapeutic practice, and test con-
struction and that this integration contributes to their research as well as
their current therapeutic practice.
11
than 7 years in secrecy to the problem and finally solves it.
During an interview by reporters about his great achievement,
he joyously breaks down in tears.
rn At a soccer match in Europe, supporters of the losing team
rush onto the field, tear up the stadium, and trample 20 peo-
ple to death. They profess loyalty to their team and seek
revenge on the victors.
rn In Africa, in a poverty-stricken country containing two cul-
turally diverse Black groups, a civil war erupts over access to
power. In the resulting devastation, hundreds of thousands of
people are murdered in horrible ways by the military arms of
both sides.
rn A child falls through the snow into a frozen river and clings
desperately to a piece of ice. A stranger, passing by, sees the
child and rushes out onto the ice, risking his life to save the
child.
rn A teenager overhears his mother tell his older brother that
the younger brother will not amount to anything. Filled with
disappointment and anger, the young man goes on to West
Point and eventually becomes chief of staff of the US.Army.
After World War I1 he successfully carries out a plan, named
after him, that helps to rebuild a shattered Europe.
rn A young nun devotes her life to the care of severely ill chil-
dren and adults in India. She risks her life, yet her belief in
God and her compassion and love are stronger than her fear
of death.
Reprinted by permission of the publishers and the Trustees of Arnherst College from The
Poems of Emily Dickinson,Ralph W. Franklin, ed., Cambridge, MA: The Belknap Press of
Harvard University Press, copyright 1951, 1955, 1979 by the President and Fellows of Harvard
College.
EMOTIONS IN PSYCHOTHERAPY
NOTES ON TERMINOLOGY
Patient or Client
Emotion or Affect
Although the terms emotion and affect are widely used in clinical
practice, an aura of ambiguity surrounds their meanings. Generally, aca-
demic psychologists are much more likely to use the term emotion in their
writings, whereas clinicians are more inclined to use the term affect. All
introductory psychology textbooks have a chapter on emotion but not on
affect. In clinical writings, the word affect is used; emotion is used to denote
an emotional disorder or emotional problems.
Is there any way to establish meaningful distinctions between these
terms? Over the years some efforts have been made mainly by clinicians
to distinguish between the terms. In a textbook of psychotherapy, Langs
(1990), a psychiatrist, defined affects as manifest and surface communi-
cations (p. 295). He discussed emotions only in the context of emotional
disturbances, which he defined as all forms of psychologically and emo-
tionally founded disorders. The emotional disturbances range from char-
acterological pathology to psychosis and neurosis. They also include psy-
chosomatic and other psychologically founded physical disorders (p. 726).
Langs suggested that emotional disturbances include disturbances in affect
such as anxiety, depression, boredom, and anger, implying that affects are
the subjective feelings associated with dysfunction.
In contrast, the clinicians Greenberg and Paivio (1997) stated that
affect refers to an unconscious biological response to stimulation. It
involves autonomic, physiological, motivational, and neural processes
involved in the evolutionary adaptive behavioral response system. Af-
fects do not involve reflective evaluation. They just happen, whereas
both emotions and feelings are conscious products of these unconscious
affective processes. (p. 7)
21
factory, when strong emotions are in conflict, and when parts of the
emotion chain are disconnected.
In this chapter, I examine a number of perspectives on the na-
ture of symptoms as they relate to emotions, including those of the
DSM, the patient, and the clinician. I describe how different theoret-
ical models interpret the meaning of symptoms. I conclude the chap-
ter by describing the goals of therapy and how they are related to
changes in emotional functioning.
WHAT IS A SYMPTOM?
Symptoms in DSM-N
What does the DSM system say about how to define symptoms?More
than 1,000 people participated in the preparation of the DSM-IV (Amer-
ican Psychiatric Association, 1994). Thirteen work groups were formed,
each of which was responsible for a particular section. Empirical research
was reviewed by each group and then critiqued by hundreds of advisers.
Twelve field trials were carried out at 70 sites with 6,000 individuals to
compare alternative formulations of symptoms. The final result is an 800-
page manual that describes more than 50 broad categories of mental dis-
order and hundreds of subcategories. These include not only the tradi-
tional categories such as schizophrenia and mood- and substance-related
disorders, but also such new categories as caffeine-related disorders,
nicotine-related disorders, and learning disorders. Psychiatrists define
each mental disorder as a clinically significant syndrome
that occurs in an individual and that is associated with present distress
(e.g., a painful symptom) or disability (i.e., impairment in one or more
important areas of functioning) or with a significantly increased risk of
suffering death, pain, disability, or an important loss of freedom.
(American Psychiatric Association, 1994, p. xxi)
To obtain a clearer idea of the DSM system, one should look more
closely at the way in which the major disorders are described. The DSM-
IV describes each disorder and states the number of symptoms that define
it. The symptom descriptions for a given category range from 1 to 13, with
a median of 7. For example, the dysthymic disorder (for adults) is char-
acterized in the following way:
A. Depressed mood for most of the day, for more days than not, as
indicated either by subjective account or observation by others, for
at least two years.
Psychodynamic Approaches
Such missing capabilities are also symptoms with which clinicians deal.
Symptoms as Symbols
sonality, coping ability, and emotions. The result of such views has been
to increase the number of goals of psychotherapy held by clinicians. These
can be extensive and may include many aims. A comparison of a number
of therapists views is shown in Exhibit 2.1.
Examination of this exhibit reveals how important emotional changes
are in the judgment of clinicians. For example, McGlashan and Miller
(1982) included as goals the ability to experience the full range of affects
Everyone could in fact be right if each one did not insist on being the
only one to be right.
-Manfred Eigen and Ruthhild Winkler
39
to be somewhat narrow in focus and are usually concerned with one or
two major issues, for example, how the autonomic nervous system changes
during emotional reactions or what cognitions or appraisals are associated
with emotions. These issues are important, but a satisfactory theory of
emotion should be broad and general and should deal with a large number
of interesting questions.
There are many reasons for the confusion that exists about the nature
of emotions. One such reason is that most people have learned to be cau-
tious about accepting at face value other peoples comments about their
feelings. This is because we are aware that we censor our thoughts and
feelings and assume that other people do, too. We learn to grin and bear
it in embarrassing situations. We learn to smile even when we are sad or
angry, and we learn to put on a poker face. We do these things to avoid
criticisms from others and to try to receive respect and acceptance.
A second reason is that behaviorism has had a strong effect on the
thinking of psychologists for nearly half a century. Behaviorists held the
view that the only truly reliable objective information obtainable about
living creatures was information about their behavior (and preferably sim-
ple behavior). This attitude led to a preoccupation with conditioned re-
sponses; emotions, on the other hand, were considered to be inner states
that could not be reliably observed and were therefore outside the realm
of scientific psychology,
A third reason for the confusion about emotions stems from the fact
that psychoanalysts have pointed out that subjective reports of emotions
cannot always be accepted at face value. Not only are some emotions re-
pressed (and thus are unavailable to introspection), but others are fre-
quently modified or distorted by ego defenses.
A fourth reason concerns the language of emotions. A number of
studies have attempted to get judges (college students or professors) to
identify English words that express emotions (e.g., Averill, 1975; Clore,
Ortony, & Foss, 1987; Shields, 1984; Storm & Storm, 1987). With the
exception of relatively few terms, there is much disagreement on precisely
which words pertain to emotion and exactly what they mean.
A fifth reason for the confusions and disagreements about emotions
is a reflection of the fact that our concepts about emotions are derived
from a number of different historical traditions.
THEORIES OF EMOTION 41
His work expanded the study of emotion from the study of subjective feel-
ings to the study of behavior within a biological, evolutionary context. It
became scientifically legitimate to ask the question, In what way does a
particular emotion or behavior pattern function in aiding survival? The
evolutionary view of emotions has influenced the work of many contem-
poraries, particularly the ethologists.
A few years after William James died, another Harvard professor, med-
ical researcher Walter Cannon, began to publish a series of studies dealing
with the effect of stress on autonomic changes in animals. This work
formed the basis of his critique of Jamess theory and his development of
an alternative view of emotions.
Cannon (1929) reported that removal of certain parts of the brain in
cats produced states of sham rage that might last 2 or 3 hours. His studies
showed that the neural structure associated with the display of rage is
located in the hypothalamus of the brain and that this area might be
thought of as the seat of the emotions. This work stimulated a large
number of studies concerned with the role in emotion of neurological struc-
tures. Researchers later discovered the importance of the limbic system as
well as many other brain areas. In addition, the study of the biochemistry
of the brain in relation to emotion and psychiatric illness is a direct con-
sequence of this early work in the neurological tradition.
Near the beginning of the 20th century, Sigmund Freud and Josef
Breuer (1895/1936) published a book, Studies on Hysteria,that described
the development of his new theory of the origin of psychiatric illness. At
the same time, Freud laid the foundation for a theory of emotion.
Freud initially used hypnosis for the treatment of his patients, but he
gradually gave up this method and substituted free associations as the best
way to help patients identify their repressed memories and emotions. The
aim of therapy was no longer to abreact an emotion whose expression
had been blocked, but to uncover repressions and to replace them with
acts of judgment. Over a period of many years, Freud and his associates
built a complex theory of the origin and development of neuroses. Explicit
or implicit in psychoanalytic writings is a theory of drives, affects, stages
of emotional development, aberrations of development, conflict, mind, and
personality.
Despite extensive writings in psychoanalysis, an explicit general the-
ory of emotion was not articulated until very recently (Spezzano, 1993),
although even now psychoanalysts lack agreement about the nature of
emotions.
THEORIES OF EMOTION 43
ism and psychoanalysis have questioned (for different reasons) the validity
of reports of emotional states; and different historical traditions have fo-
cused on quite different aspects of the complex state called an emotion.
Despite these obstacles, many efforts have been made, particularly in
recent years, to develop theories of emotion. However, some have focused
on evolutionary aspects, some on brain function, some on autonomic phys-
iology, some on cognitive aspects, and some on psychotherapeutic issues.
Many of these theories have been reviewed previously (Plutchik, 1980a,
1994). Because the focus of this book is on clinical implications of emotion
theories, this chapter is concerned with those theories that have specific
implications for understanding clinical problems.
The selection of the most clinically relevant emotion theories is not
without controversy. Although most clinicians discuss the emotions of
their patients, relatively few, however, have made an explicit attempt to
present a comprehensive theory of affects. Even Freud's theory of affect
(see Plutchik, 1994) was primarily about anxiety rather than affect in gen-
eral.
In my judgment, the most important contributors to a general psy-
choanalytic theory of affect are Rado, Brenner, and Spezzano, all of whom
have written books about emotions within a psychoanalytic context. This
is not true of other important psychodynamic contributors such as Horney,
Sullivan, and Malan. There are many nonpsychoanalytic theories of emo-
tion in existence (for a description, see Plutchik, 1980a); most deal with
academic issues such as the role of autonomic changes in subjective reports,
and few have direct relevance to clinical practice. In my judgment, recent
books by Tomkins, L. Vaillant, R. Lazarus, and Greenberg deal most di-
rectly with emotions as applied to the practice of psychotherapy, and this
is why they are described in this chapter.
What is common to all of the authors that I have selected for dis-
cussion is that they all recognize that emotions are central to therapy and
that emotions are usually attempts to adapt to challenging aspects of the
environment, particularly the human environment. Most recognize that
emotions are not always available to introspection and that people mis-
judge their own feelings. The reader should bear in mind that these authors
discuss emotions in relation to psychotherapy; they do not necessarily pres-
ent general theories of treatment or particular schools of practice.
THEORIES OF EMOTION 45
emotion and not be aware of it. Although Freud wrote about unconscious
guilt and unconscious anxiety, he was dissatisfied with this idea, because
he considered an emotion to be a response process. In The Unconscious
(1915), he wrote,
It is surely of the essence of an emotion that it should enter conscious-
ness. So for emotion, feelings, and affects to be unconscious would be
quite out of the question. But in psychoanalytic practice we are ac-
customed to speak of unconscious love, hate, anger, etc., and find it
impossible to avoid even the strange conjunction, unconscious con-
.
sciousness of guilt. . . Strictly speaking . . . there are no unconscious
affects in the sense in which there are unconscious ideas . . . . (p. 110)
Only when Freud developed his later interpretation of anxiety did he re-
solve the dilemma. He finally concluded that the evaluation of an event
can be unconscious even though the response process is not (e.g., a free-
floating anxiety is evident, but the source of it, i.e., the evaluation, is not
recognized).
A second implication concerns the question of how to recognize emo-
tion in others. If it is true that emotions may be repressed, how can the
analyst identify something that even the patient cannot identify?
Freud assumed that various displacements and transformations may
occur in the expression of an emotion but that indirect signs of its presence
are always noticeable. For example, if someone continually frowns, grinds
his or her teeth, and has dreams in which people are being murdered, we
might conclude that this person is angry even if he or she denies it. Freud
relied heavily on dreams, free associations, slips of the tongue, postures,
facial expressions, and voice quality to arrive at judgments about a persons
repressed emotions. In other words, in the Freudian psychodynamic tradi-
tion, an emotion is a complex state of the individual that one infers on the
basis of various classes of behavior. Although subjective feelings may pro-
vide a clue to a persons emotions, they are only one type of evidence
among many others. An emotion is not synonymous with a verbal report
of a supposed introspective state.
A third implication of the psychodynamic tradition is that emotions
are seldom if ever found in a pure state. Any emotion has a complex
history, with elements that go as far back as infancy. An emotion may have
several drive sources and may include a mixture of feelings and reactions.
The very idea of psychoanalysis implies an attempt to determine the ele-
ments of the complex state.
THEORIES OF EMOTION 47
quently. The number of emotions exhibited is much greater than four basic
ones.
The fourth level of regulation of action, the ulwmotional thought level,
involves the mastery of events by rational, intellectual means alone. Rado
(1969) then defined emotion as the preparatory signal that prepares the
organism for emergency behavior. . . . The goal of this behavior is to restore
the organism to safety (p. 27).
As a practicing psychoanalyst, Rado regarded these ideas as meaning
ful only in relation to their role in the treatment of patients. He therefore
wrote at some length about the practical implications of his views and
claimed that disordered behavior is fundamentally an overreaction. A per-
son who experiences pain, fear, rage, or other emergency emotions tries to
get rid of the cause by withdrawal, submission, or combat. These emergency
reactions often do not work and instead create an extreme, somewhat rigid
style of behavior.
Rados conceptions of emotions are original and thought provoking,
evidently influenced by Cannons (1929) ideas on fight and flight as emer-
gency reactions. Some of his ideas, such as those relating to the social
communication value of emotions, are similar to Darwins. Fundamentally,
however, he wrote within the Freudian tradition that acknowledges the
existence of unconscious and mixed emotions whose characteristics can
only be inferred on the basis of indirect evidence.
TABLE 3.1
Labeling of Affects in Terms of Hedonic Tone and Idea
Label Hedonic Tone Idea
Anxiety Unpleasure Danger
Fear Unpleasure Imminent danger
Panic Intense unpleasure Imminent danger
Worry Mild unpleasure Uncertain danger
Sadness Unpleasure Object loss or physical in-
iuy
Loneliness Unpleasure Longing for lost object
Despair Unpleasure No hope of relief from loss
Misery Intense unpleasure No hope of relief from loss
Discontent Mild unpleasure No hope of relief from loss
Shame Unpleasure Public defeat or failure
Embarrassment Mild unpleasure Public defeat or failure
Happiness Pleasure Fantasy or experience of
gratification
Ecstasy Intense pleasure Fantasy or experience of
instinctual gratification
Triumph Pleasure Defeat of rival
From On the Nature and Development of Affects: A Unified Theoty, by C. Brenner, 1974,
Psychmnalflic QuatferY, 43,532-556. Copyright 1974 by Psychoanalytic Quarterly, Inc. Used with
permission.
THEORIES OF EMOTION 49
feelings of unpleasure connected with the idea that something bad is about
to happen, depression is defined as feelings of unpleasure associated with
the idea that something bad has already happened. The something bad
may be a narcissistic injury or humiliation; it may be a person or other
object one has lost; it may be a bad deed one has committed or a
brutal punishment one is suffering; it may involve physical pain, men-
tal anguish or both. (Brenner, 1975, p. 11)
Brenner stated that the experience of loss need not be based on a real loss;
even a fantasized loss may bring about the affect of depression.
In regard to both depression and anxiety, the appearance of the affect
triggers some kind of ego defense such as repression, denial, or projection.
These defenses function to reduce the feelings of unpleasure. However, ego
defenses are seldom completely efficient in reducing a danger or a loss; the
final result is always a compromise between the affect and the reaction to
the affect (the defense). A symptom, such as a phobia, or a personality
trait, such as submissiveness, may express the compromise.
These ideas are represented schematically in Figure 3.1. The percep-
tion of a situation as dangerous or as implying a personal loss leads to the
development of the affects of anxiety or depression or both. Because these
affects are unpleasant, various ego defenses (depending on the individuals
personal history) then begin to act to reduce the feelings of unpleasure.
Because most defenses are not entirely successful, a compromise results.
The compromise involves the formation either of a symptom or of a char-
acter trait.
What are some of the practical, clinical implications of these views?
For one thing, Brenner (1975) insisted that there is no such thing as free-
floating, or content-less, anxiety.
When a patient complains of anxiety, but has no conscious knowledge
of what it is that he fears, analysts assume that the nature of his fear,
the something bad that is about to happen, as well as all the other
associated ideas are unconscious. They assume that it is repression and
other defenses that are responsible for the fact that the patient himself
is unable to say what it is he fears, to give any content to his anxiety.
(P. 18)
Second, in line with the theory that affects trigger ego defenses that func-
tion to minimize the unpleasant affect, the presence of overt anxiety or
depression indicates a failure of defense. It means that the individual has
been unsuccessful in reducing the unpleasant affect. This condition implies
that the therapist should examine the problem of why the ego defenses are
not working. Such an examination may provide insights into personality
dynamics that the therapist may not otherwise recognize. A third impli-
cation of Brenners views relates to the use of the term depression. He
pointed out that it has been used in two senses: as an affect state and as
Repression
Denial
Undoing
Projection
I
Displacement
THEORIES OF EMOTION 51
Psychological life begins with affects before the development
of ideas and the recognition of objects.
Affects interact with each other. For example, anxiety inhib-
its sexual excitement.
Affects are modes of communication and action predisposi-
tion. In other words, affects imply action; for example, fear
implies escape, shame implies hiding.
We all have predispositions to maximize or minimize specific
emotions.
Neuroses are unconscious strategies for managing ones affec-
tive life.
Spezzano argued that affects have an intimate relationship to drives
or motives. To achieve safety and survival, individuals are born with the
capacity to feel anxiety. To procreate, individuals are born with the poten-
tial to feel sexual excitement and affection. To withdraw from a hopeless
situation, individuals are born with the capacity to withdraw and feel de-
pressed. Affective meanings are implied in all human experience although
their unconscious sources often make them difficult to identify. Children
experience the need or drive for nurturance, safety, power, curiosity, con-
trol, and autonomy. The emotions are the methods by which such drives
are satisfied.
With regard to issues of treatment, Spezzano proposed that the de-
velopment of symptoms is always an attempt to regulate ones own affects.
For example, he believed that narcissism is a perversion of both sexual
excitement and curiosity. Narcissism involves a central conflict between
security and risky choices. Narcissistic persons tend to have feelings of
certainty and perfection as defensive reactions to unsatisfactory events.
In therapy, clinicians recognize that patients are not the final au-
thorities on their own affective states.
They claim that they are feeling nothing while simultaneously saying
and doing things that would be hard to imagine being done or said by
someone who felt nothing. They can also claim they feel one affect
while talking or acting in ways we more commonly expect from people
feeling a different affect. (p. 53)
Affects are inferred from complex sources of information, only one of
which is patient verbalizations.
Psychoanalysis also has some interesting things to say about the re-
lations between emotions and personality or character. It is a common
clinical experience to encounter patients who feel anxious, angry, or guilty
most of the time. Such persisting states of emotion are constantly being
generated because they keep the patient ready to deal with threats to his
or her needs for psychic safety. The process becomes circular because a
person in (for example) a state of anxious expectation finds an endless
THEORIES OF EMOTION 53
and tend to have a rhythmic pattern. Affects can become associated with
almost any stimuli (through learning) and can exist for long or short per-
iods of time. Affects are stronger than drives, according to Tomkins; to get
a person to act, all we need do is create an emotional state (e.g., joy, anger,
or shame), regardless of his or her state of drive. A person who is frightened
by a car runs, regardless of whether he or she is hungry or thirsty.
These ideas seemed academic and not clearly related to clinical issues,
but in recent years several clinicians have attempted to develop these con-
cepts so as to be useful in a therapeutic context. The most detailed elab-
oration may be found in the work of Leigh McCullough Vaillant (1997).
TABLE 3.2
Adaptive and Maladaptive Forms of Sadness
Adaptive Maladaptive
Concern for self Self-blame, self-pity, self-attack
Hopeful about the future Hopeless about the future
Good memories are accessible Bad memories dominate
Feels close to others Feels distant from others
Observer feels compassion Observer feels helpless or irritated
Sadness comes to an end Sadness persists
Note. From Changing Character: Short-TermAnxiety-Regulating Psychotherapy for Restructuring
Defenses, Affects, and Aftachmenfs, by L. M. Vaillant, 1997, New York: Basic Books. Copyright
1997 by Basic Books. Reprinted by permission.
THEORIES OF EMOTION 35
Richard Lazarus: Coping With Emotions
Richard Lazarus, a professor emeritus of psychology at the University
of California in Berkeley, has been concerned during much of his career
with the relations between stress and coping in adults (Lazarus, 1991).This
research gradually led him to realize that stress and coping are part of a
larger area of study of the emotions.
According to Lazarus, the study of emotion must include the study
of cognition, motivation, adaptation, and physiological activity. Emotions
involve appraisals of the environment and of the individuals relationships
with others and his or her attempts at coping with them. Lazarus therefore
referred to his theory as a cognitive-motivational-relational (Lazarus,
1991, p. 87) system of explanation with the focus being on the person-
environment relationship.
The central idea of the theory is the concept of appraisal, which refers
to a decision-making process through which an individual evaluates the
personal harms and benefits existing in each interaction with the environ-
ment. Primary appraisals concern the relevance of the interaction for ones
goals, the extent to which the situation is goal congruent (i.e., thwarting
or facilitating of personal goals), and the extent of ones own ego involve-
ment (or degree of commitment). Secondary appraisals are those in which
the individual makes decisions about blame or credit, ones own coping
potential, and future expectations. In this view, emotions are discrete cat-
egories, each of which can be placed on a weak-to-strong continuum. Sev-
eral emotions can occur at the same time, because of the multiple moti-
vations and goals involved in any particular encounter, and each emotion
involves a specific action tendency (e.g., anger with attack, fear with es-
cape, shame with hiding).
A key ingredient of his concept of secondary appraisal is the idea of
coping, which refers to ways of managing and interpreting conflicts and
emotions. According to Lazarus, there are two general types of coping pro-
cesses. The first is problem-focused coping, which deals with conflicts by
direct action designed to change the relationship (e.g., fighting if threat-
ened). The second is emotion-focused (or cognitive) coping, which deals with
conflicts by reinterpreting the situation (e.g., denial in the face of threat).
The concept of appraisal implies nothing about rationality, deliberateness,
or consciousness.
Another important aspect of Lazaruss theory is the concept of core
relational themes. A cme relational theme is defined as the central harm or
benefit that occurs in each emotional encounter. For example, the core
relational theme for anger is a demeaning offense against me and mine;
for guilt it is having transgressed a moral imperative; and for hope it is
fearing the worst but yearning for better (Lazarus & Lazarus, 1994, p.
20). One implication of these ideas is that emotion always involves cog-
THEORIES OF EMOTION 57
dividuals relations with the environment, particularly the environment of
other people. Many emotions, although not all, have unique action ten-
dencies; for example, impulses to attack when angry, to run away if fright-
ened, or to seek contact if joyful. However, complex emotions such as
jealousy or pride are believed to have no characteristic facial expressions
or action tendencies (Greenberg & Korman, 1994).
The emotion system integrates information across the variety of
information-processing domains and, as such, is the most complex subsys-
tem humans possess. Emotions, Greenberg believed, provide a constant
readout of an individuals current state and one therefore of central concern
to psychotherapy. Clients need to be brought to conscious awareness of
their emotions whenever possible to help improve their orientation to the
environment and to help them mobilize their efforts for goal-directed ac-
tion (Greenberg 6r Safran, 1990).
The process of psychotherapy involves at least four aspects or phases:
(a) bonding with the client; (b) evoking the emotions that reflect emotion
schemes, which express how individuals think about themselves; (c) ex-
ploring emotion schemes in detail through examination of the idiosyncratic
meanings that situations hold for each person; and (d) restructuring the
emotions through various therapeutic interventions. An example of the
restructuring of emotions is through use of role-playing techniques to en-
courage the client to resolve unfinished family relations. Another aspect
of this process is to help individuals accept their emotions in whatever
form they appear, with the goal of eventually achieving some degree of
control over their modes of expression. Some of the active techniques used
by the therapist to achieve these goals is to focus on the present, to analyze
facial and bodily expressions, to encourage the intensification of specific
emotions, and to focus on goals and future plans (Greenberg & Paivio,
1997).
CONCLUSION
59
Some important similarities between emotions and personality
traits are discussed. Both use a similar and highly overlapping lan-
guage, both serve communicationfunctions in interpersonal relations,
and both regulate the relations among individuals. I conclude the
chapter by offering several different but overlapping definitions of the
term emotion based on an evolutionary framework.
PSYCHOEVOLUTIONARY THEORY 61
tions is their bipolar nature. In everyday experience we tend to think about
emotions in terms of opposition; we talk about happiness and sadness, love
and hate, fear and anger. Thus, one may conclude that the language of
emotions implies at least three characteristics of emotions: (a) they vary
in intensity, (b) they vary in degree of similarity to one another, and (c)
they express opposite or bipolar feelings or actions.
It is possible to combine these three ideas of intensity, similarity, and
polarity of emotions by means of a simple three-dimensional geometric
model that looks like a cone. The vertical dimension represents intensity
of emotion, any cross-sectional circle represents similarity of emotions, and
bipolarity is reflected by opposite points on the circle. This cone-shaped
model looks very much like the well-known color solid that describes the
relations among colors, and in fact many observers over the years have
remarked on the similarity between emotions and colors in terms of their
general properties (e.g., intensity, hue, and complementarity; Plutchik,
1980a).
To these ideas is added one important concept to complete the struc-
tural model. From at least the time of Descartes (1596-1650), philosophers
have assumed that there is a small number of primary emotions and that
all others are derived from them. Descartes listed 6; Spinoza, 3; Hobbes,
7; McDougall, 7; and Cattell, 10 (Plutchik, 1980). In more recent years,
investigators have proposed from 3 to 11 emotions as primary. All include
fear, anger, and sadness, and most include joy, love, and surprise (Kemper,
1987).
If we combine the idea of primary emotions with the three charac-
teristics of the language of emotion, we can conceptualize a three-dimen-
sional structure with eight slices representing the (assumed) basic emotions.
This is shown in Figure 4.1 The idea that there are 8 basic emotions is a
theoretical one but should be evaluated partly in terms of the inferences
and insights to which it leads, the research it suggests, and the extent to
which empirical data are consistent with it.
If we imagine a cross section through this three dimensional structure
which may be called an emotion solid, we obtain an emotion circle as
shown in Figure 4.2 for a midlevel cross section on the intensity dimension.
A number of studies summarized in Plutchik (1980b) and Plutchik and
Conte (1997) support this circular or circumplex set of interrelations
among emotions. Table 4.1 provides a listing of the empirically determined
angular locations of a large number of emotion concepts. For example,
starting with the emotion accepting arbitrarily set at 0", the word apathetic
is 90" away from it, whereas revolted is opposite on the circumplex at 181".
The word dventurozls is at 270" and is therefore opposite the term apathetic.
Many other pairs of opposites are found on the circle.
If there are 8 basic emotion dimensions (each with a number of syn-
onymous or related terms), how can we account for the total language of
PSYCHOEVOLUTIONARY THEORY 63
Figure 4.2. A circumplex for emotions based on a cross-section of the emotion
solid. Primary dyads are formed by combining adjacent pairs of basic emotions.
6z Potkay, 1981). Often the same adjective checklist can be used to mea-
sure both states and traits by a simple change in instructions. If the research
participants are asked how they feel now or how they felt within the past
few days or so, they are being asked about emotional states or moods. If,
however, they are asked to describe how they usuaUy feel, they are being
asked about personality traits. Thus, according to this theory, emotions and
personality traits are intimately connected, and in fact, personality traits
may be considered to be derived from mixtures of emotions. This idea of
derivatives of emotion is elaborated later in the chapter.
PSYCHOEVOLUTIONARYTHEORY 65
TABLE 4.2
Judges Attributions of Words Appropriate to the Description of
Mixed Emotions
Primary emotion components Labels for the equivalent mixed emotions
+
Joy acceptance - Love, friendliness
Fear + surprise - Alarm, awe
Sadness + disgust - Remorse
Disgust + anger - Contempt, hatred, hostility
+
Joy fear - Guilt
Anger + joy - Pride
+
Fear disgust - Shame, prudishness
Anticipation + fear - Anxiety, caution
Note. From Emotion: A Psychoevolutionary Synthesis (p. 162),by R. Plutchik, 1980, New York:
Harper & Row. Copyright 1980 by Harper & Row. Reprinted by permission.
PSYCHOEVOLUTIONARYTHEORY 67
THE COMPLEX CHAIN OF EVENTS DEFINING AN EMOTION
1
I FEEDBACK LOOPS
I
THE COMPLEX CHAIN OF EVFNTS DEFINING "FEAR"
Threat
by "Danger"
Predator
I I
No
Reduce Threat Danger
1 FEEDBACK LOOPS
Impulse Reintegrate
to cry with lost
mother or
substitute
-
FEEDBACK I.OOPS
Figure 4.3. The Complex Chain of Events Defining an Emotion. The top panel
illustrates feedback loops for emotions in general, and the middle and bottom
panel illustrate feedback loops for fear and sadness, respectively.
influence the impulses to action, the feeling states, the cognitions, and the
initiating stimulus. This process is what leads to the idea that feelings and
behaviors can affect cognitions, just as much as cognitions can influence
feelings. Also implied by this model is the idea that the term feelings is
used to represent subjective, reportable states such as joy, sadness, anger,
or disgust, whereas the word emotion is used in a much broader sense to
refer to the entire chain of events that include feelings, but also cognitions,
impulses to action, display behaviors, and the various loops that occur. An
individual may not be consciously aware of some of these components.
Table 4.3 summarizes the theory's assumptions about some of the key
elements involved in the emotion sequence. For each of the 8 basic emo-
tions a general description of the stimulus event that triggers it is provided,
followed by descriptions of the probable cognitions associated with each of
the emotions, the subjective feeling states, the overt behaviors, and the
effect of the behavior in reducing the disequilibrium.
At the heart of all these descriptions is the idea that emotions have
<
a purpose in the lives of individuals. This idea stems from the evolutionary
perspective, is consistent with psychodynamic thinking, and is becoming
more and more accepted in the writings of contemporary clinicians. For
example, Hauser (1996) wrote that the primary care that young organisms
require is for food, protection, and transportation and that crying is a major
method for getting such care. Spezzano (1993) suggested that individuals
use love or intimidation to keep others invested in their personal agendas.
Vaillant (1997) has discussed the adaptive functions of a number of emo-
tions. Sorrow, for example, increases ones feelings of closeness to others,
and listeners often feel compassion and wish to be helpful. Interest, or
anticipation, is often energizing and increases ones involvement with oth-
ers. Fear protects the self, initiates withdrawal, and allows general func-
tioning to continue. Shame leads to remorse and a decrease in the prob-
ability of repetition of the shameful act. All these examples imply that
emotions are part of an adaptive circular or feedback process.
PSYCHOEVOLUTIONARYTHEORY 71
lated domains such as personality. It is in this sense that personality traits
are derivatives of the more fundamental emotional states, just as most
colors in nature are derived from mixtures of a few primary ones. When
emotions occur in persistent or repeated form in an individual over long
periods of time, we tend to consider them as more or less permanent (dis-
positional) characteristics of the.individua1. We then tend to use the lan-
guage of personality traits to describe the person rather than the language
of emotional states. The idea of derivatives is shown in Table 4.4.
This table describes a number of conceptual languages that the psy-
choevolutionary theory assumes are systematically related to one another.
For example, proceeding from left to right across the table, the term fear
is part of the subjective language of emotions, as are terms like anger, joy,
and surgnse. The second column describes the function of each emotion
from an evolutionary point of view. The function of fear is protection; of
anger, the deseruction of a barrier to the satisfaction of one's needs; of sad-
ness, symbolic reintegration with a lost object in the form of nurturance;
and for disgust, the rejection of a toxic substance or experience.
When an individual's emotional states persist over time or are fre-
quently repeated, we tend to describe the individual as having a particular
personality trait. Thus, repeated expressions of fear lead to the designation
of someone as timid. Repeated expressions of anger or irritability lead to
the description of someone as quarrelsome, and repeated expressions of
rejection of others leads to such trait designations as hostile or cruel.
When personality traits exist in fairly extreme form, we use a new
language to describe the situation: the language of personality disorders.
Thus, a person who has an extreme form of quarrelsomeness (plus some
other characteristics) may be diagnosed as having an antisocial personality
disorder, and a person who shows an extreme form of timidity might be
diagnosed as a dependent personality type. Similar parallels may be drawn
for each of the major clusters of personality traits, which are in turn derived
from the basic emotions.
The ego-defense language and coping style language are theorized to
be ways of dealing with particular emotions. Ego defenses are unconscious,
for the most part, whereas coping styles are conscious methods people use
to deal with problems that generate emotions. These ideas are further elab-
orated in chapters 5 and 6.
In an examination of this issue (Plutchik, 1997), I gave three reasons
that support the existence of a relationship among emotions, personality,
and interpersonal relations: (a) there is extensive overlap of the language
describing emotions and personality, (b) the circumplex model describes
the interrelationship of emotions and those of personality traits very well,
and (c) there is considerable overlap of functions of both emotions and
traits.
Psychoanalysts have had the most to say about the functional signif-
icance of personality traits. For example, Fenichel (1946), a major synthe-
sizer of psychoanalytic ideas, has described character (personality) as the
precipitates of instinctual conflict. In his view, the conflict of emotions
leads to fixations and a freezing of emotional tendencies. Such a process
transforms transient emotional reactions into persistent personality traits.
Rapaport (1950) noted that children show their emotions in transient ways
but that in later life anxiety is continuous in the anxious person, the pes-
simist is permanently melancholy, and the cheerful person consistently
buoyant.
PSYCHOEVOLUTIONARYTHEORY 75
Another psychoanalyst, Spezzano (1993), has argued that an explicit
theory of affects is embedded in psychoanalytic writing and that psycho-
analysis is in fact primarily a theory of affect. Among the points he made
is the idea that psychopathology is always an attempt at affect regulation.
This implies that psychopathology, which generally means in this context
character neuroses or personality disorders, has a function: to regulate in-
terpersonal relations. We use love to keep others invested in our personal
agendas. We use intimidation to inhibit interactions that would be painful
or threatening or to gain power over others. Psychoanalytic interpretation
is concerned with the patients affects, particularly with how patients de-
ceive themselves about their own affects. Self-deception has an obvious
function, that is, to mitigate the pain of recognizing our own limitations
and our own anxieties.
Nonpsychoanalytic writers also have contributed to the concept of
the functional value of personality traits. Millon (1994), for example, has
argued that personality refers to an individuals lifelong style of relating to
others, to coping with problems, and to expressing emotions. These rela-
tively stable patterns of thinking and interacting have the overall function
of using, controlling, or adapting to external forces. The expression of
personality traits tends to evoke reciprocal and often predictable responses
from others that influence whether an individuals problems decrease or
stabilize.
Millon (1994) has implied that chronic emotional patterns (i.e., per-
sonality traits) such as anxiousness, depression, or self-criticism serve a
variety of goals: they produce such secondary gains as eliciting nurturance
from others; they excuse the avoidance of responsibilities; they rationalize
poor performance; or they justify the expression of anger toward others. He
raised the question of what turns a transient emotion into a chronic per-
sonality trait and suggested that this occurs because the range of experi-
ences to which people are exposed throughout their lives is both limited
and repetitive (p. 287).
When this analysis is applied to chronic sadness or melancholy as a
trait, it is generally recognized that the most common precipitating event
for sadness is a loss of something or someone important to the individual.
This loss often results in characteristic facial expressions and vocalizations
(such as crying or distress signals). Such distress signals typically produce
an empathic response in adults who are exposed to them, a feeling often
followed by some attempt at helpful actions. Chronic depression as a trait
thus may be considered to be an extreme and persistent distress signal that
continually functions to solicit help from others. This may be true regard-
less of whether the individual is aware of this function.
Cantor and Harlow (1994) suggested that the function of the trait of
social anxiety is to solve the problem of insecurity by allowing an individ-
ual to accept the lead of other people in social situations. People with
A DEFINITION OF EMOTION
PSYCHOEVOLUTlONARY THEORY 77
three components (subjective feelings, overt behavior, and physiological
changes) is hardly an adequate description of the complexities described
in this and the previous chapters.
Another way to define emotions is to list their major properties.
1. Emotions are communication and survival mechanisms based
on evolutionary adaptations. This is simply a recognition that
emotions increase the chances of individual survival through
appropriate reactions to adversities in the environment (e.g.,
by fight or flight). Emotional displays also act as signals of
intentions of future actions.
2. Emotions have a genetic base. This is a recognition that nei-
ther humans nor animals teach their infants and children
how to express emotion, although it is possible for individuals
to learn how to inhibit the expression of emotions. Consid-
erable evidence now indicates that genetic predispositions
underlie emotional expressions.
3. Emotions are complex chains of events with stabilizing neg-
ative feedback loops that attempt to produce some level of
behavioral homeostasis. The chain of events includes the
cognitive elements in emotion, as well as the impulses to
action and the inhibiting forces that operate.
4. There is a small number of basic, primary, or prototype emo-
tions, and all others are mixtures, compounds, or blends of
the primary emotions. This fact leads to the recognition of
the basic interrelations between emotions and personality
traits. Personality traits are seen as compromise formations
based on conflicts and the repeated mixing of basic emotions.
5 . The relations among emotions can be represented by a three-
dimensional structural model. In this model, the vertical di-
mension represents the intensity of emotions, the circle or
circumplex defines the degree of similarity of the primary
emotion dimensions, and polarity is represented by opposite
emotions on the emotion circle.
6. Emotions are hypothetical constructs whose existence and
properties are determined by various indirect lines of evi-
dence. We are never certain of exactly what emotion some-
one else has because of the complex nature of emotions and
because more than one emotion may occur at the same time.
Any given display of emotion may reflect such complex states
as approach and avoidance, attack and flight, sex and a g
gression, or fear and pleasure. We are often not even certain
of our own emotions.
7. Emotions are related to a number of derivative conceptual
PSYCHOEVOLUTIONARYTHEORY 79
EMOTIONS AND
5
PERSONALITY DISORDERS
The pain of acute or chronic negative affect lies at the heart of those
patterns of emotionality now termed the affective and personality
disorders.
-M. J. Mahoney
81
predicts a circumplex or circular ordering of similarity of emotion concepts.
This has been demonstrated empirically by Plutchik (1980a), Russell
(1989), G. A. Fisher et al. (1989, and others.
One of the hypotheses generated by the theory is that personality
traits should also have a circumplex structure, and there is much supporting
evidence for this idea (see Plutchik & Conte, 1997). Another derivative
hypothesis is that personality disorders are extreme forms of certain per-
sonality traits and should therefore have a similar circumplex structure.
This hypothesis applies only to the personality disorders and not to psy-
chiatric diagnoses in general.
A number of studies have examined the degree to which personality
disorder diagnoses can be related to one another by means of a circumplex
structure. In this chapter I review some of those studies.
The 4th edition of the Diagnostic and Statistical Manual of Mental Dis-
orders (DSM-IV) identifies a personality disorder as
an enduring pattern of inner experience and behavior that deviates
markedly from the expectations of the individuals culture, is pervasive
and inflexible, has an onset in adolescence or early adulthood, is stable
over time, and leads to distress or impairment. (American Psychiatric
Association, 1994, p. 629)
called borderline in about 30% of the cases, histrionic in about 20% of the
cases, antisocial in about 10% of the cases, and narcissistic in less than
5%. Again, comorbidity is a matter of degree.
In a study of 404 adult outpatients with major depression, Fava et al.
(1996) found that most had one or more comorbid diagnoses of avoidant,
histrionic, narcissistic, and borderline disorders. Klein, Lewinsohn, and
Implications
Diagnostic Clusters
Over the years a number of attempts have been made to describe the
relations among the personality disorders by means of a circumplex. One
of the problems has been the lack of a consistent terminology for person-
ality disorders as described in the DSM series. For example, DSM-11 (1968)
listed 10 personality disorders; 3 of them (explosive, asthenic, and inadequate)
were later dropped. Plutchik and Platman (1977) studied the remaining 7
-compulsive, cyclothymic, hysterical, paranoid, passive-aggressive, schizoid, and
sociopathic-for degree of similarity. To these they added one more term:
well-djusted.
Twenty psychiatrists were asked to think of patients who had been
diagnosed with each of the labels and to select emotion words (such as
gloomy, sociable,or impulsive) that described each patient. The psychiatrists
choices were scored in terms of the eight basic affect dimensions of the
Emotions Profile Index (Plutchik & Kellerman, 1974). This procedure pro-
vided an emotion profile for each diagnosis.
These profiles were then intercorrelated for all possible pairs of di-
agnoses. The matrix of intercorrelations was then factor analyzed using the
principal-components method, and it was found that the first two factors
accounted for 91% of the variance. The factor loadings for each diagnosis
were plotted using the first two axes, which resulted in the circumplex
shown in Figure 5.1.
This figure indicates that personality disorders fit into a circumplex
structure, with cyclothymic opposite compulsive, hysterical opposite schizoid,
and well-adjusted opposite paranoid. Some spaces are found that could rep-
resent other personality disorders, not defined in DSM-11 but which appear
in the third edition of the DSM (DSM-III; American Psychiatric Asso-
ciation, 1980) and DSM-IV. It is important to emphasize that this circular
INTROVERTED
t f
Schizoid Dependent UNASSUMING-
INGENUOUS
/
Passive-
Aggressive
LAZY-
SUBMISSIVE
figure 5.2. Wigginss (1 982) Interpersonal Types (Outside Perimeter) and
Corresponding Diagnoses (Inside Perimeter). From Structural Approaches to
Classification, by R. K. Blashfield, in Contemporary Directions in
Psychopathology: Toward the DSM-IV (p. 334),edited by T. Millon and G. L.
Klerman, New York: Guilford Press. Copyright 1986 by the Guilford Press.
Adapted with permission.
Deficit Disorder
Adjustment Disorder
Major Depressive
Disorder
I
Anxiety Disorder
Figure 5.3. An Approximation to a Circumplex for Preadolescent Psychiatric
Disorders Based on a Confusion Matrix. From Co-Occurrence of Psychiatric
Disorders in Child Psychiatric Patients and Nonpatients: A Circumplex Model,
by C. R. Pfeffer and R. Plutchik, 1989, Comprehensive Psychiatry, 30, p. 280.
Copyright 1989 by W. B. Saunders Company. Reprinted with permission.
EMOTIONS A N D P E R S O N A L T Y DISORDERS 91
BORDERLINE 0
that are similar to those of the paranoid diagnoses. The second cluster, the
dramatic grouping, is not confirmed empirically. Narcissistic and antisocial
are found to be similar and are related to the proposed sadistic diagnosis.
Passive-aggressive is also found to be part of this grouping. This cluster
seems to be centered around aspects of aggression and might properly be
labeled the aggressive cluster.
The traditional anxious cluster purportedly consisting of avoidant, de-
pendent, obsessive-compulsive, and passive-aggressive is not confirmed. The
empirical locations suggest that the avoidant and dependent diagnoses are
highly similar to one another and are similar to the self-defeating and dys-
thymic disorders. This modified version of the anxious cluster should be
called the anxious-depressed cluster instead.
Of some interest is that the histrionic and borderline diagnoses are near
each other on the circumplex and are also near the dysthymic diagnosis.
They probably could be fit into the anxious-depressed cluster. The presence
of strong features of both anxiety and depression in these two diagnoses
supports this placement.
One may think of these findings shown in Figure 5.4 as providing a
measure of the degree of overlap of personality disorders. Diagnoses that
are close on the circumplex are likely to be confused, whereas those that
are further apart are rarely confused.
The modified method of paired comparisons used in this study has
revealed an empirical circumplex for the personality disorders. It shows the
traditional clusters to some degree but with some important differences.
The so-called erratic cluster seems clearly to be related to problems of han-
dling aggression. The anxious cluster includes self-defeating persohality and
dysthymic personality, even though dysthymic is not included in Axis 11.
This cluster might be called the anxious-depressed cluster. Emotions appear
to be related to all of the personality disorders.
These findings help demonstrate that some degree of comorbidity ex-
ists for all personality disorders and that there is a gradual transition from
one personality disorder to another in terms of similarity. Strictly speaking,
this implies that clusters are somewhat arbitrary and are based on arbitrary
selection of boundaries. The circumplex concept implies that all person-
ality disorders, those that are now recognized and those that may be clin-
ically labeled in the future, can be represented by placements on a circle
varying in degree of closeness.
Table 5.3 helps explain the partially arbitrary nature of the personality
disorders; it compares the labels given for personality disorders in the dif-
ferent DSM editions, as well as in a recent psychoanalytically oriented
listing. A number of the diagnostic labels have changed over time, and the
definitions themselves have been modified as well. There is no reason to
believe that this process of addition and subtraction of terms and redefi-
nitions will not continue into the future. It is likely that this process is a
Implications
The following list summarizes some of the ideas that have been pre-
sented thus far concerning the circumplex for personality disorders:
1. There is now considerable evidence based on different meth-
ods and patient populations that personality disorders vary in
degree of similarity to one another and show polarities as
well. These facts can be best described by means of a circum-
plex.
2. The exact number of personality disorders as well as the most
appropriate ways of labeling and defining them are still a
matter of controversy. The controversies are largely a func-
tion of how one chooses to group the elements of overlapping
categories. Changes will probably continue to be made in the
future.
3. The existence of overlapping categories is one of the reasons
that most patients are given several personality disorder di-
agnoses. This is also the reason for the relatively low relia-
bility of diagnoses in the personality disorder domain.
4. It is evident that degree of conflict within the individual is
I07
DECEPTION
We are all aware that normal social interactions are not entirely
truthful. We censor what we tell other people and hide many of our feel-
ings. When someone asks how we feel, we are unlikely to give a complete
rundown on all the aches, pains, problems, and emotions we are currently
experiencing; in most cases we simply give a socially expected response.
Such responses are, in fact, deceptions, but deceptions that are acceptable
within the broad purview of social interaction and are generally designed
to help interactions run smoothly or to avoid embarrassment. Most clini-
cians see such inhibitions of expression from their patients particularly in
the early stages of therapy.
Of much greater clinical significance are patient self-deceptions. Cli-
nicians recognize that respectable codes of oughts and shoulds, duties
and obligations, may conceal self-deceptions. Even when a patient vol-
unteers an appraisal of how he feels it is usually so saturated with a wish
to make his feelings appropriate that the report is hardly trustworthy
(Weisman, 1965, p. 226). Psychoanalysts believe that most people are
faulty observers of their own affective states (Spezzano, 1993) and that the
perception of other people is also inaccurate. Facial expressions are not
necessarily a readout of inner emotional states but are usually designed to
influence the emotional states and behaviors of other people. For example,
smiles are often seen when adults greet one another, but they do not nec-
essarily reflect feelings of pleasure or happiness. Smiles are usually a way
of telling a speaker that one is listening, that one understands what is being
said, or that one agrees with what is being said. The smile acts to maintain
a relationship between a speaker and a listener without necessarily express-
ing any emotional state at all.
Similarly, a crying face is a signal that one needs or wishes to receive
help. A threat face indicates that one is ready to fight or that one has the
ability to fight. In most situations, people use facial expressions to try to
influence others so they may get what they want. Although this might be
called deception, it does not imply some kind of evildoing. Deception, as a
form of protection, is found widely throughout the plant and animal king-
dom. Camouflage markings are forms of deception, as are eyespots on the
wings of butterflies. Like human facial displays, these are survival-related
adaptations.
Everyone has secrets. According to Yalom (1995), the two most com-
mon secrets relate to ones feelings of inadequacy or incompetence and
ones lack of caring or love for someone close. That such secrets are not
revealed is a form of deception. However, many deceptions are not con-
scious. For example, the descriptions of a marriage by the two partners are
often disparate and also different from that of an interested friend. Such
differences may be deliberate or may be unconscious efforts to avoid shame
or humiliation. In a therapeutic context, a patient who wants the respect
and esteem of the therapist has difficulty in exposing what he or she be-
lieves to be weaknesses.
There are many reasons for inaccurate self-descriptions. First, there is
a barrier between experience and language. The attempt to change a dif-
fuse, chaotic emotional experience into a coherent organized narrative dis-
torts the experience. Second, there is always a process of selection, often
unconscious, about what one chooses to disclose; something is always left
out. Third, experiences of emotion may be too painful to verbalize but may
be partially expressed in nonverbal forms, that is, changes in facial ex-
pression, posture, tone, and skin color. The sheer complexity of a life makes
accurate communication extremely difficult.
Deception-and I am not using the term in a pejorative sense-is a
normal part of life and an integral experience in psychotherapy. Sigmund
Freud recognized this a long time ago; he described deception as an aspect
of ego defenses and developed a theory about how defenses function in
therapy and in life (Freud, 1915/1957). Although Freuds theories have
been criticized during the past 100 years, his concept of ego defenses has
been accepted and incorporated into textbooks, clinical practice, and daily
life. In the next sections I examine in detail the origins of the concept of
ego defenses and relate these ideas to emotions and clinical practice.
COPING STYLES
Mapping
One way that individuals deal with problems is by using their innate
curiosity and intelligence to get more information about the problem. If a
person goes to a physician and describes headaches, a rash, and a slight
fever, the physician will probably ask for more information about feelings
and symptoms and perform blood tests, take X rays, and make other eval-
Avoiding
Help Seeking
People may solve problems by asking for help. Sometimes help seek-
ing is carried out informally. For example, people call their friends to get
opinions and advice about various life problems. Relatives may take turns
helping someone who is ill. Neighbors frequently do errands and favors for
each other. These are all ways in which people seek help.
Sometimes difficult life problems may require help from an expert.
For example, going to a doctor, taking a car to a service station, consulting
a therapist or a clergy member, writing to an advice column, dealing with
a financial advisor, or joining a support group are all ways in which people
seek help.
Minimizing
Reversing
Blaming
Sometimes life creates problems for which there are no direct solu-
tions. Substitution refers to indirect methods of coping. For example, some-
one who has an unpleasant job but for various reasons cannot leave it
might make an effort to do enjoyable things such as hobbies, travel, or
exercise during hours when he or she is not working. Couples who cannot
have children frequently adopt or take foster children into their home.
Sometimes people turn to alcohol and drugs as a form of substitution for
the anger they may feel toward an insensitive supervisor. What all these
approaches have in common is that they represent indirect substitute so-
lutions to problems.
Improving Shortcomings
IMPLICATIONS
127
theories of emotion and some of their implications for therapy. In the
present chapter 1 consider various methods and tactics that clinicians may
use to encourage the expression of emotions, to change emotions, and to
understand them when they appear. Some of them are well-known to cli-
nicians; others may not be. All are derived from, or are consistent with,
the psychoevolutionary theory. In each case, the tactic is described and is
followed by a very brief clinical illustration.
All emotion theories recognize that stimuli per se are not the crucial
determinants of an emotional reaction; what determines emotions are the
interpretations (evaluations or cognitions) that one makes of stimuli and
events. People do not automatically become emotional at what others say;
they first need to interpret comments as insults or threats before they ex-
perience anger or as compliments before they experience pride or joy. This
leads to the idea that one way of dealing with stressful life events-that is,
events that produce unpleasant emotions-is by consciously redefining (i.e., re-
conceptualizing) the stimulus or situation m by putting it into a new context.
A woman felt angry, resentful, and depressed because of an abusive
relationship with an alcoholic husband. When she began to think of
him as sick rather than as cruel, she felt less angry and sad and
When something goes wrong many people have a strong urge to find
an explanation or a scapegoat. They try to account for their unhappiness,
depression, anxiety, or anger by relating it to a dull job, a demanding boss,
or an unfaithful spouse. Sometimes they may blame their neighborhood,
their parents, or their siblings.
Such attitudes are expressions of the individuals feeling of loss of
some degree of control over his or her life. They are also expressions of
the belief that events directly determine our emotions, when in fact, it is
our interpretation of events that determines our emotions. Cognitive eval-
uations of life events determine what we feel, and to that extent, our world
of emotions is created by our cognitions.
This is true also of our past. Everyones past is complex, ambiguous,
and impossible to define precisely. Recognizing that our cognitions deter-
mine our emotional world implies that our cognitions also determine our
conception of our own past. So-called bad pasts can be reinterpreted in
more benign ways just as our conceptions of an unsatisfactory job can be
reinterpreted to make it less stressful or boring. These changes can be
brought about by the use of various coping styles described in a previous
chapter.
One member of a therapy group was 70 years old. She was married to
a former alcoholic who was insensitive, withdrawn, and sometimes de-
manding. After several years in group therapy in which coping styles
were actively taught, she changed her coping styles so that she handled
problems differently. She began to accept things she could not change;
she became less angry, she stopped ruminating about her unhappy
childhood; and she began to do more things that pleased her (like
travel). She used the coping styles of minimization, suppression, and
Emotions are reactions to life events and are attempts to deal with
them in some ways. For example, both depression and suicidal thinking
can be cries for help, even when the patient is not fully aware of what
kind of help is needed. When multiple, troublesome, and difficult life
events occur to an individual at the same time, the pressures may become
overwhelming and produce depression and an urge to escape it by means
A client was asked to describe her good qualities. She said that she
was caring, polite, intelligent, resourceful, kind, and able to laugh at
her own problems. When asked to describe qualities with which she
was not satisfied, she said that she was short-tempered, stubborn, in-
secure, a spendthrift, and inclined to walk away from a disagreement.
The therapist selected one of these traits and asked her how she de-
veloped her stubborn streak and what value it had for her currently.
In responding to this question she explored feelings of resentment to-
ward her brother, who was her fathers pet. Being Stubborn was the
only way that she could get what she wanted. Currently, her stub-
bornness was a way that she used to avoid feelings of being controlled
by other people.
The tactics described in the preceding section are useful for dealing
with emotions but do not exhaust the range of possibilities. Vaillant (1994)
has described interventions that may assist in the experiencing of affects.
These are discussed below.
You just pulled away from the joy (or sadness or anger or tenderness)
that you were feeling as you described (that situation) with (that specific
person). Can you sense that? (p. 201).
You have made two fists with your hands. What do you think you
might be feeling? (p. 202).
So you dont feel angry at all now? Have you evm had an incident
in your life when you were really furious at someone? (p. 204).
Are there any thoughts or images that come with that sorrow? Say
whatever comes to mind . . . What would you want to say to him if he
was here right now? (p. 206).
You seem much more comfortable with angry feelings now. But are
there more positive sides of the relationship that need to be remembered
as well, to put the anger in perspective? What touches you most about
your husband? (p. 209).
Vaillants Conclusion
CONCLUSION
139
can interact with them, and they must somehow come to terms with the
limited length of an individual life. These four areas of concern are fun-
damental in the sense that they all relate in some way to issues of inclusive
fitness and the likelihood of sexual reproduction and maintenance of one's
genes in future generations. I refer to those issues as the problems of hier-
archy, territoriality, identity, and temporality (Plutchik, 1980a).
An understanding of these existential problems is relevant to clinical
practice. The general principle is this: Knowledge of an existential crisis reveals
the underlying emotions involved.
HIERARCHY
TERRITORIALITY
In every species, each organism must learn what aspects of the en-
vironment and of the self belong to it, that is, it develops a sense of
tenitoriality. From an evolutionary point of view, territories define an area
or space of potential nourishment necessary for survival or an area that is
safe from attack or predation. Territories may be defined explicitly by scent
markings, tree scratches, or boundary lines or implicitly by the distance
one organism allows another to approach before aggression is initiated.
Crowding usually generates territorial crises.
Individuals attempting to cope with territorial issues are concerned
with feelings of possessiveness, jealousy, and envy. Those who are in pos-
session of some aspect of the environment (including other people) feel in
control. In contrast, individuals whose boundaries have been penetrated
(or whose possessions have been taken) feel despair and lack of control.
Control issues and preoccupations are commonly seen in patients who en-
ter treatment.
IDENTITY
TEMPORALITY
1. Who Am I?
The question How can I reach this goal? is Concerned with skill
acquisition and competence. If you know where you want to go, do you have
the skills to enable you to get there? In recent years, a considerable liter-
ature has developed that suggests that social-skills training is very effica-
cious in producing therapeutic changes (Liberman, Mueser, & Wallace,
1986). Social-skills training is concerned with such fundamental skills as
having a conversation, making friends, sizing people up, courting, con-
ducting a sexual relationship, negotiating, and parenting. From a broad
psychoevolutionary point of view, the development of such skills is essen-
tial to accomplishing most life goals and increasing inclusive fitness (i.e.,
the likelihood of ones genes being represented in future generations).
Clinical Implications
I49
by Krebs, Davies, and Parr (1993): communication is the process in which
actors use specially designed signals or displays to modify the behavior of
reactors (p. 349). Linguists recognize that human language is different
from nonhuman language. Pinker (1994), a psycholinguist, observed that
The human vocal tract provides a selective advantage over other config-
urations because (a) non-nasalization allows sounds to be more easily iden-
tified; (b) it produces sounds with distinct spectral peaks, resulting in fewer
listening errors; and (c) it provides a greater rate of data transmission than
other communication systems (Hauser, 1996).
At least two other important aspects of speech are relevant to psy-
chotherapy. The content and the form of speech provide information about
the emotional and motivational states of a speaker. Speech provides both
digital and analog coding. Digital coding (the use of discrete words to convey
information) is believed to be a late phylogenetic development. Analog
coding refers to the graded signals varying in intensity, frequency, or tempo
that convey information about emotional states. Humans use graded vocal
signals just as lower animals do to convey emotional states.
The second aspect of speech relevant to psychotherapy is based on
communicative displays, which are usually the result of more than one
behavioral impulse in conflict (Hahn & Simmel, 1976; Wilson, 1975).
Attack and retreat, affinity and sexuality, caregiving and exploration all
interact to produce the graded facial, vocal, and postural signals that de-
termine appropriate social interactions. Evidence from studies of animals,
children born deaf and blind, and preliterate and isolated groups of humans
demonstrates that facial expressions of rage, surprise, fear, and happiness
are universal and probably have an innate basis. However, human beings
have highly developed facial musculature, and a large number of facial
expressions can be voluntarily created and given arbitrary meanings akin
to those of a language. In ordinary interactions between humans, there is
a subtle interplay between innate display signals that are characteristic of
humans and those conventional expressions that people learn. Anthropol-
ogists have also suggested that language activities have been selected during
evolution as a means of social manipulation in the context of subsistence
activities (Parker, 1985). A similar view has been presented by Fridlund
( 1994), who has provided evidence that facial expressions function pri-
A PROPOSED MODEL OF
PATIENT-THERAPIST COMMUNICATIONS
P: You know, I feel like Im going to be released from this room and
that Im going to be raging, in a raging fury, and nobody will know
why. [laugh] [inaudible] I just walk along, you know, nice and straight.
If I get angry enough all at once, then would I get over it? Primal
scream. I cant imagine, you know, feeling really, feeling like there isnt
anything wrong with me. I was thinking about that the other day.
What would it be like, you know to feel that you really just, you know,
you were where you ought to be, and everything is just really full? (p.
43)
Every verbal interaction between two people has elements of ambi-
guity, incongruity, and vagueness in it. Despite this, conversations usually
go on as if the participants are either unaware of the partial incoherences
or are able to ignore them.
Therapist
communications into meaningful response categories theoretical categories
sentences (e.g., interpret, (e.g., diagnoses,
provoke, self-disclose, goals of treatment,
mirror, empathize) concept of
vulnerability)
Figure 9.7. Preliminary Statement of the Major Elements Involved in a Therapists Interventions in Response to Patient
Communications. From Strategies of Therapist Interventions: A Preliminary Empirical Study, by R. Plutchik, H. R. Conte, S. Wilde,
and T. B. Karasu, 1994, Journal of Psychotherapy Practice and Research, 3, p. 332. Copyright 1994 by American Psychiatric Press.
Reprinted with permission.
c
b
\
with various feedback loops. An example of a feedback loop may be the
countertransference reaction of the therapist, of which he or she may not
be aware, that triggers defensive behaviors or resistances in the patient.
Knowledge of this circular, feedback process may sharpen a clinicians
awareness of the role that therapy plays in the shaping of his or her re-
sponses to patient communications. This feedback model has also provided
the theoretical basis for an empirical study of the various categories of
response that clinicians use during the psychotherapeutic encounter.
In a study of the issues raised by this model of patient-therapist
interactions, my colleagues and I reviewed a large number of psychotherapy
transcripts representing different schools of therapy and different points of
view (Plutchik, Conte, Wilde, & Karasu, 1994). The aim of the review
was to identify the nature and basis of therapist interventions during psy-
chotherapy. Previous reports had suggested categories such as questioning,
advising, interpreting, and reflecting (Stiles, 1979) or categories such as
getting information, support, focus, and clarification and providing hope
(Hill & OGrady, 1988). We believed that a review of a large number of
transcripts would enable us to identify the implicit categories used by ther-
apists when making interventions. We also hoped to identify, through a
survey of experienced clinicians, what kinds of interventions would be
considered appropriate and what kinds inappropriate.
To accomplish this latter aim, we identified 41 patient communica-
tion categories from the various transcripts. Examples of such communi-
cations are: (a) suicidal thoughts, (b) complaints about a lack of progress
in therapy, (c) an intention to harm someone, (d) sexual thoughts toward
the therapist, and (e) a desire to prolong the session. The 41 communi-
cations were then presented to a group of seven experienced clinicians who
provided a list of possible responses that a therapist could reasonably make
to each communication. This resulted in from 5 to 8 possible therapist
responses for each item. Possible therapist responses include (a) asking for
associations, (b) ignoring it, (c) pointing out the patients sarcasm, and (d)
looking for historical antecedents.
Patient remarks and possible therapist responses were then compiled
in a survey form and were mailed to members of the clinical psychiatry
faculty at the Albert Einstein College of Medicine; 141 responses were
obtained.
The clinicians were given the list of patient communications and a
list of 5-8 possible responses that one might make to each communication.
They were asked to rate the extent to which they agreed or disagreed with
each possible response to each patient communication. A 5-point scale was
used, with responses ranging from strongly disagree to strongly agree. An
additional analysis by a separate group of clinicians attempted to codify all
the possible therapist responses into a small number of categories.
Table 9.1 provides examples of clinicians responses considered to be
1. If your patient describes his or her Ask how long he or she has had
problems.. . them.
2. If you do not understand the meaning Express your confusion or lack of
of a particular communication . . . understanding.
3. If your patient constantly complains Bring this to his or her attention.
...
4. If your patient expresses sexual feel- Explore further thoughts, fantasies,
ings toward you ... and dreams that the patient has
about you.
5. If your patient reports a dream . . . Explore the affect in the dream.
6. If your patient is silent for what ap- Comment on that fact.
pears to be a long time . . .
7. If your patient reveals suicidal idea- Explore fantasies of what suicide
tion . . . might achieve.
8. If your patient reveals inconsisten- Ask if the patient is aware of these
cies in his or her behavior in similar inconsistencies.
situations . . .
9. If your patient focuses excessively on Explore the possibility that this is a
historical materials . . . way of avoiding present issues.
10. If your patient appears to become Inquire about the patients feelings
overanxious while talking . . . at that moment.
Note. Appropriate items were selected on the basis of the highest clinician ratings, as well as high
agreement (low variability of judgment) among clinicians. From Strategies of Therapist
Interventions: A Preliminary Empirical Study, by R. Plutchik, H. R. Conte, S. Wilde, and T. B.
Karasu, 1994, Journal of Psychotherapy Practice and Research, 3, p. 329. Copyright 1994 by
American Psychiatric Press. Reprinted with permission.
8 TABLE 9.3
5 An Empirical List of Therapist Intervention Categories and Their Definitions
2 Intervention category Definition Example
-I
3 1. Educate Provide specific information to the patient. For ex- It is important for you to talk about your child-
ample, explain something about normal child- hood because things that happened then
20 hood development to a parent who is upset by can influence the way you feel now.
=! a childs behavior.
2. Gather information Ask the patient to provide present or past specific Please tell me about your work history.
biographical information. Have you ever seriously comtemplated sui-
cide?
3. Define therapeutic struc- Indicate to the patient what is acceptable and un- If you miss sessions you need to pay for
a
8 ture acceptable behavior in the therapy relationship. them.
8
-I
I cant accept presents from you.
4. Support self-control Help the patient set limits on the expression of You can think whatever you want, but you
his or her emotions or thoughts. dont have to act out your thoughts.
rr 5. Make a self-disclosure Reveal personal information about yourself (as Im sorry Im late, but my car broke down.
< therapist). Yes, I am married and have three children.
6. Boost morale Say or do something designed to make the pa-
tient feel better.
You are doing very well.
You showed a lot of courage under the cir-
cumstances.
7. Encourage elaboration/ Encourage the patient to generate more thoughts Can you tell me more about that?
verbalization and feelings about a given topic. Hmm.
8. Explore affects Ask the patient to elaborate on his or her feelings How did you feel about that?
and emotions.
9. Explore patientltherapist Relate the patients behavior, thoughts, or feelings You seem to be angry at me.
relationship to you (as therapist). I notice that every time I go away on vacation
you are late for the next session.
10. Interpret resistance Make a connection between what the patient is You always seem to change the subject when
doing, saying, thinking, or feeling at the mo- I mention your father. I wonder if you are
ment and the fact that therapy is being im- avoiding the topic?
peded.
11. Interpretlsearchfor pat- Identify repetitive patterns in the patients behav- You always seem to fall in love with married
tern iors or identify common features underlying dif- men.
ferent behaviors or feelings.
12. Interpretlsearch for pur- Try to determine what the patients behavior is Do you think that if you act helpless people
pose trying to accomplish. will take care of you or not abandon you?
Do you think that always being late will bring
attention to you?
+I 13. lnterpretlsearch for proxi- Try to identify a thought process that connects a You seem to be more nervous than usual
mate cause recent event with some aspect of the patients since you got stuck in the elevator.
-u current behavior.
rn
2n 14. Bring behavior to patients Bring some aspects of the patients current be- You sound angry.
attentionlsharpen focus havior or verbalizations to his or her attention. You sound like youre ambivalent about your
0 boss.
0
15. Redirect the patient Propose that the patient think, feel, or behave dif- If people criticize you, stand up for yourself.
C
P ferently. I think you should make a list of things to do
to help you get a new job.
Note. From Strategies of Therapist Interventions: A Preliminary Empirical Study, by R. Plutchik, H. R. Conte, S. Wilde, and T. B. Karasu, 1994, Journal of
5*
Psychotherapy Practice and Research, 3, p. 331. Copyright 1994 by American Psychiatric Press. Reprinted with permission.
3z
create problems for them. One problem is that we do not always know the
reason we do things. If a mother says to a child Why did you knock over
my favorite lamp while playing in the living room? what can the child
say? If the child says it was an accident, this does not really answer the
mothers question. The child might have a number of other thoughts about
it. For example, the child might think, Because Im clumsy, or Because
Im stupid, or Because Im mad at you for making me go to bed early.
None of these responses, even if true, are acceptable either to the mother
or the child. More likely, the child is simply unaware of any plausible
reason for the action.
This point is also true for patients in psychotherapy. They often do
not know the reasons for the behaviors they engage in or the emotions
they have with which they are dissatisfied. They have only the vaguest
ideas about why they keep checking to see that the gas is off, why they
lose their tempers easily, why they sometimes have suicidal thoughts, or
why they feel love (or hate) toward the therapist. Even when a patient
can cite what seems like a plausible reason for a feeling or behavior, ther-
apists recognize that all actions are multidetermined and many previous
experiences and emotions enter into a single current feeling or behavior.
Recognizing one or two components of an event does not mean that the
event is fully understood.
Both adults and children feel defensive and uncomfortable when
asked why questions. For the most part such questions are put-downs and
the implied response is a negative one. Asking an adult Why didnt you
get that promotion? leads to the feeling Because Im not competent.
Why is your room always so sloppy? implies the response Because Im a
slob. Thus, why questions often seem to press people to supply an internal
stable attribute (or trait) to account for implicitly undesirable actions.
In summary, why questions imply a hierarchical dominance relation
between the questioner and the one being questioned, and they have no
truly adequate answers. The one being questioned may have to lie to get
around them gracefully. It is also likely that the person asking the question
is not really interested in the answer but rather in the implied right to ask
the question; often there is an implied insult. Because of normal social
expectations, most people who are asked why questions try to answer them
in some way. However, because motives are not often clear, this may lead
to exaggerations or lies.
Sometimes therapists may ask why questions partly because they wish
to discover the exaggerations or lies that patients use when faced with an
ambiguous or embarrassing situation. However, to assume that a patients
answer to a why question is complete and accurate would be naive. If the
ideas that have been presented are correct, does this mean that the ther-
apist should never ask the patient why he or she feels or does things?
As mentioned above, why questions may sometimes provide the ther-
APPROPRIATE INTERVENTIONS
THERAPEUTIC COMMUNICATION 1 65
emotions. A better intervention might have been, I wonder if you are
silent because of all the emotions that are churning around inside of you.
A good interpretation tries to convey the message that it is all right to
look at ones conflicts if one wishes to and that it is not dangerous for the
patient. It also reflects a sense of empathy with the emotions of the patient
and a sense that the therapist knows how it feels and will not criticize,
rebuke, or blame the patient for her emotions and conflicts.
Good therapist interventions should avoid implicit or direct criticisms
of the patient or an implication that the patient is childlike or immature.
They should avoid static images that suggest that a person has a fixed
personality style that is not likely to change. Rather than say something
like You seem to be a shy person, a better alternative comment might
be I notice you talk more easily at some times than at other times. The
aim of the intervention is to help the patient feel that the therapeutic
conversation is like a mutual exploration of considerable interest to both
parties, rather than an interrogation designed to drag information out of a
reluctant witness. The therapist must help the patient grasp the truth
about his life, but the nature of that truth is continually changing (Wach-
tel, 1993, p. 157).
Wachtel suggested the following approaches to take when making an
intervention:
Avoid diagnostic terms (e.g., words like narcissistic or bor-
derline).
Avoid telling the patient what he or she really means.
Describe behavior as temporary or transitional.
rn Assume that the patient already knows what you are about
to tell him or her (e.g., As I know youre aware . . . ).
rn Clarify for the patient who owns the problem.
Let the comment point toward implied action (e.g., It
sounds like what you might like to do or say is . . . ).
Most experienced therapists probably use many of these ideas. The
key is for the therapist to avoid an adversarial relationship with the patient
and not to use power in too obvious a way. The patient should feel that
there is nothing more important to the therapist than the attention de-
voted to the patient during the therapeutic encounter.
CONCLUSION
169
tried to identify the differences between appropriate and inappropriate in-
terventions. This research has also led to a feedback model of the patient-
therapist interaction as well as an empirically determined list of types of
therapist interventions.
Some concepts presented in this book may be new or different in
focus from what is sometimes taught. This may result in disagreements by
the reader with some of the ideas presented here. Such disagreement is
inevitable in a field that is said to contain more than 300 different schools
of therapy.
In this book, I have not outlined another school of therapy. However,
I have examined the many direct and subtle ways that emotions influence
and are influenced by psychotherapy. Because all therapists deal with emo-
tions, perhaps this focus may help integrate some of the diverse views of
therapy and at the same time facilitate the process of therapy. I hope that
the ideas presented here are clear and interesting enough to stimulate se-
rious thought. Perhaps that is the best one can hope for in the complex
exchange between writer and reader.
Because of the great diversity of therapeutic theories and styles, this
book is necessarily incomplete. For example, in recent years there has been
an increasing recognition of the role of evolution in psychology. This de-
veloping literature is not only concerned with the issues of nature and
nurture and their interactions, but also with how evolutionarily stable ad-
aptations have emerged at different periods of human history and now
continue to have an effect on human thought and behavior. This is es-
pecially true in the case of maleness and femaleness, but it is also true of
more subtle interactions between people. This is a literature that has begun
to be extensively explored by many disciplines, but despite some impressive
insights, the conclusions are still the source of continued controversy.
These theories probably justify more attention than I have devoted to them
here.
Therapeutic communication is an extremely complex process, and
there is still a great deal that is not known about how it works best. I hope
that the ideas in this book stimulate others to continue the process of
filling in the missing parts, I hope that the future mosaic will be a design
full of beauty and elegance and powerful in its ability to affect human life.
171
in !he previous chapters has some implications for assessment of emotions.
For example, cognitive theories usually describe the situational and con-
ceptual triggers of emotional reactions, and such reactions are assessed by
means of self-reports. Motivational theories are likely to direct the re-
searchers attention to autonomic changes that occur within the body and
to use facial expressions as key indicators of emotion. Evolution-based the-
ories are likely to focus attention on the measurement of expressive be-
havior of humans and animals, whereas psychoanalytic theories imply that
projective and drawing techniques best reflect the unconscious mixed emo-
tional states typical of humans.
However, overlapping theoretical ideas require overlapping measure-
ment techniques as well. It is possible to identify four general approaches
to measuring emotions, most of which tend to be used by proponents of
all viewpoints.
One method involves the use of self-reports of subjective feelings, a
procedure that it useful mainly with human adults. A second method is
through ratings made of the behavior of an individual. Such ratings can
be used with adults, children, people with mental retardation, and lower
animals. A third method is through a rating of the product of someones
behavior (e.g., an individuals handwriting or figure drawings). Finally,
emotions may be assessed through the use of recordings of physiological or
neural changes.
These methods are described and illustrated in detail in Plutchik
(1994) and Plutchik and Kellerman (1989). Rather than summarize this
information, I focus here on a number of measurement scales that have
been based directly on the psychoevolutionary theory of emotion described
in chapter 4.
172 APPENDIX
TABLE A.l
The Emotion-Mood Index
Trust Depression Aggression
-Trusting ____ Depressed -Aggressive
Friendly
___ -Gloomy ___ Furious
-Obliging -Sad -Bossy
~Contented Empty -Boastful
-Cooperative Lonesome
___ ___ Annoyed
-Tolerant Helpless
___ _.__Quarrelsome
-Calm Discouraged
___ ___ Irritated
~Patient -Hopeless Angry
Dyscontrol Distrust Gregarious
-Alert -Disgusted -Sociable
-Fascinated -Uninterested ____ Generous
___ Surprised ~ Bored ~ Cheerful
~ Confused -Distrustful ___ Affectionate
____ Attentive -Bitter Happy
-Wondering ~ Sarcastic ____ Satisfied
-Puzzled ___ Resentful ___ Delighted
~ Bewildered -Fed up ___ Pleased
Timidity Control Activation
-Afraid ~Hopeful -Slowed-down
Scared
___ Inquisitive
___ ___ Sluggish
-Nervous -Curious ~ Relaxed
~Timid ~Eager ____ Weak
-Worried -Interested -Active
~Anxious -Daring -Strong
Shy ~Impulsive ____ Energetic
~Cautious -Nosy ___ Restless
Note. The adjective checklist is theory based. From Emotion: A Psychoevolutionary Synthesis, by
R. Plutchik (1980a), p. 206. Copyright 1980 by Harper & Row. Reprinted with permission.
APPENDIX 173
nificantly discriminated between the normal and depressed states. Three
scales-Depression, Aggression, and Control-discriminated between the
normal and manic states. It thus appears that the Emotion-Mood Index
is capable of distinguishing among several affective states.
An unpublished study using this adjective checklist was con-
cerned with the conceptions held by people as to what their best and
worst moods are like. To answer this question, 33 evening college stu-
dents were asked to complete this checklist under three conditions: (a)
How do you feel right now! (b) HOWwould you describe the best you
have ever felt! and (c) HOWwould you describe the worst you have ever
felt?
Results of these self-ratings showed that the best mood is described
as one that is high in feelings of cheerfulness, trust, and curiosity and
extremely low in feelings of sadness, boredom, fear, and anger. The worst
mood is highest in sadness, fearfulness, and boredom (in descending order);
it lacks happiness, trust, or interest. In addition, the best mood includes
feelings of activity and energy, whereas the worst mood includes feelings
of sluggishness and weakness. The product-moment correlation between
the best and worst moods is -.76, implying that they are essentially op-
posite in character. The now mood correlated .63 with the best mood and
- .24 with the worst.
If we consider the worst mood these people ever experienced, it ap-
pears that the dimension of depression is the most strongly represented.
The words that make up this dimension are depessed, gloomy, sad, empty,
lomsome, helpless, discouraged, and hopeless. The experience of loss, separa-
tion, and mourning is apparently a more distressing experience than that
of fear or worry. A related finding was reported by Plutchik (1970) in a
study of ideal and least-liked self images. The major differences between
these two kinds of self-descriptions were found to be in the depression and
destruction dimensions; that is, individuals liked least the moods of sadness
and anger. These findings are only preliminary, but they support the hy-
pothesis that depression may be more distressing than anxiety even though
anxiety has often been called the core of neurosis. It is also possible that
depression is more common in everyday life. The two studies cited here
using the Emotion-Mood Index simply illustrate the potential usefulness
of a theory-based adjective checklist.
One of the advantages of mood checklists is their comparative brevity.
Lubin (1966) has shown that it is possible to reduce the length of several
depression checklists from 34 adjectives to 17 and still demonstrate high
internal correlations as well as significant correlations with other depression
scales. It is also possible to reduce the length of a checklist to a single
word per dimension and still discriminate between conditions.
Table A.2 shows such a checklist, which uses one word to represent
each of the basic affect dimensions, along with a 5-point intensity scale
174 APPENDIX
TABLE A.2
A Mood Rating Scale Using One Word for Each Affect Dimension
Happy
Fearful I I I I I
I
~~
Interested I I I I
Disgusted
Sad
Surprised
Note. From Emotion: A Psychoevolutionary Synfhesis, by R. Plutchik (1 980a), p. 208. Copyright
1980 by Harper & Row. Reprinted with permission.
ranging from not at all to very strongly. It assumes that because words like
sad, sorrowful, or grief-stricken all represent different levels of the same basic
emotion dimension, repeating them all in a checklist is unnecessarily re-
dundant. Instead, the dimension can be sampled with a single term such
as sad, and individuals can make an intensity rating for that word.
To test the usefulness of such a brief affect rating scale, I asked a
group of 40 college students to complete it at the beginning of each Mon-
day, Wednesday, and Friday class during 1 week (Plutchik, 1966). This
represented the control condition. The mood scale was then given just
prior to an examination and just after the exams were returned to the
students. Analysis of the affect ratings showed that all eight moods re-
mained stable during the control week. Ratings made just before the ex-
amination showed highly significant increases in ratings of fearful and in-
terested and highly significant decreases in ratings of happy and agreeable.
The other four emotions did not show any significant changes.
On the test return day, the students were given their examination
papers and were allowed to see their grades. Affect ratings were then ob-
tained again. Under these conditions, seven of the eight emotions showed
highly significant changes in mean self-ratings. There were significant de-
creases in happy, agreeable, and interested and significant increases in an-
gry, disgusted, sad, and surprised. These findings suggest that these single
adjective mood scales are sensitive to stresses, cover a wide range of affect
states, and have theoretical relevance (Plutchik, 1966).
APPENDIX 175
This same mood rating scale has been used as part of a battery of
tests designed to identify changes in elderly (mostly welfare) tenants in a
single-room occupancy hotel in New York City (Plutchik, McCarthy, &
Hall, 1975). These tenants were assessed just after a new medical and social
services program was introduced directly into the hotel and again assessed
1 year later. Among the changes that took place during that period was a
significant increase in feelings of anger and sadness. No significant changes
occurred in the other emotions. To explain these results, the authors hy-
pothesized that the tenants increase in feelings of frustration was associated
with their rising expectations. Despite the concerns of the staff, relatively
few improvements in living conditions were noted during the 1st year.
Adjective checklists for the measurement of emotional states have
come into wide use in recent years. Their advantage is that they are usually
brief, have obvious face validity, and can be easily self-administered. They
can also be used to provide indices of transient states of emotion or mood
as well as long-term emotional dispositions. Their disadvantages include
that they are easy to fake and that relatively little validation has been done
on clinical populations. In addition, many of the checklists have no the-
oretical justification for the particular dimensions or scales that are scored.
Despite these problems, such checklists represent a useful addition to the
other ways of measuring emotions. Russell and Carroll (1999) review some
of these issues.
176 APPENDIX
The EPI is a forced-choice test. The person taking it is simply asked
to indicate which of two paired words is more self-descriptive;for example,
is he or she more quarrelsome or shy? The choices are scored in terms of
the primary emotions implied by the trait word. Each time the respondent
makes a choice between two trait words, he or she adds to the score on
one or more of the eight basic emotion dimensions. Thus, rather than
measure only anxiety, the test also simultaneously measures anger, sadness,
joy, and so on. Because the implications of the choices are not always clear
to the respondent, the test has something of a projective quality; the re-
spondent does not usually recognize the implicit scoring system. Finally,
because of the forced-choice format of the EPI, it tends to reduce response
bias associated with a set to choose socially desirable traits. This is true
because many of the choices must be made between two equally undesirable
or two equally desirable traits. In addition, a bias score is built into the
test as a measure of the respondents tendency to choose socially desirable
(or undesirable) traits in those cases in which the items are not matched
(Kellerman & Plutchik, 1968).
The following 12 terms are used in the EPI: udventurous,affectionate,
brooding, cautious, gloomy, impulsive, obedient, quarrelsome, resentful, self-con-
scious, shy, and sociable. A brief definition is provided in the test for each
term. The total score for each of the eight primary emotion dimensions is
converted into a percentile score on the basis of data obtained from 500
men and 500 women. These people represent a broad range of individuals
characterized by a lack of overt pathology or psychiatric hospitalization.
The percentile scores are then plotted on a circular diagram, as illustrated
in Figure A.l for patients with severe depression. The center of the circle
represents 0 percentile, and the outer circumference of the circle is the
100th percentile. The larger the dark wedge-shaped area, the stronger the
emotional disposition that is revealed. Details of scoring and plotting may
be found in the published manual (Plutchik & Kellerman, 1974).
Although the EPI has been used in a variety of settings, I present
here a brief review of its use in clinical studies. Fahs, Hogan, and Fullerton
(1969) showed that the Depression Scale of the EPI discriminated clearly
between a group of depressed patients in a hospital and a control group.
Conte and Plutchik (1974) demonstrated that those patients who were
admitted to a mental hospital after a suicide attempt were significantly
higher on the Depression and Aggression Scales of the EPI than a matched
group of nonsuicidal patients. A study by Fieve, Platman, and Plutchik
(1968) demonstrated that the EPI Depression Scale could be used to assess
the effects of two antidepressant drugs, lithium and imipramine.
The EPI has provided the basis for emotion profiles for several clinical
groups: narcotic addicts (Sheppard, Fiorentino, Collins, & Merlis, 1969);
geriatric patients (Plutchik & DiScipio, 1974); alcoholic individuals with
Korsokoffs syndrome (Plutchik & DiScipio, 1974); asthma patients (Plut-
APPENDIX 177
Figure A. 7. Depression Profile Obtained From a Group of Manic-Depressive
Patients. From The Psychology and Biology of Emotion by R. Plutchik, p. 117.
Copyright 1994 by Robert Plutchik. Reprinted with permission.
chik, Williams, Jerrett, Karasu, & Kane, 1978), Japanese individuals with
schizophrenia, neurosis, or alcoholism (Hama, Matsuyama, Hashimoto, &
Plutchik, 1982); women with premenstrual syndrome (Henderson & Whis-
sell, 1997); and patients with acute coronary heart disease (Veselica et al.,
1999). A depression profile obtained from a group of manic depressive
patients is shown in Figure A.l.
178 APPENDIX
On the basis of the empirical groupings of terms, eight clusters-
Aggressive, Assertive, Sociable, Accepting, Submissive, Passive, Depressed,
and Rejecting-were identified in sequence around the circumplex. The
trait terms argumentative and belligerent were a part of the Aggressive cluster,
obedient and docile were part of the Submissive cluster, and the Rejecting
cluster included such terms as obstinate, stubborn, and spiteful.
The first version of the test was administered to both patient groups
and nonpatients; a number of item analyses were carried out, and Conflict
and Social Desirability subscales were constructed. Internal reliability of
the scales ranged from .76 to .87. Some evidence for construct validity is
seen by the fact that a Self-Esteem Scale correlated significantly and neg-
atively with the dimensions of Submissive, Passive, Depressed, Rejecting,
and Aggressive and significantly positive with Accepting, Assertive, and
Sociable. Normative data are available on 282 nonpatients for each of the
eight scales. When several clinical populations were compared with the
nonpatients, it was found that patients with affective disorders scored sig-
nificantly higher than the nonpatients on the Depressed, Passive, and Sub-
missive Scales and significantly lower on the Assertive, Sociable, and Ac-
cepting Scales. A group of alcoholic individuals on a detoxification ward
were found to be significantly higher than nonpatients on the Passive,
Depressed, and Submissive Scales and lower on the Accepting Scale. The
highest conflict scores were found in substance abuse outpatients and bor-
derline patients.
The version of the Personality Profile described above was based on
ratings made of single personality trait terms. In using the scales with hos-
pital patients, it was found that some terms were unfamiliar to some pa-
tients. Therefore, a second version (Conte, Plutchik et al., 1991) of the
Personality Profile was constructed using short sentences that defined each
trait. Thus, for each of the 89 trait terms on Form A, there are 89 corre-
sponding statements on Form B. Correlations between the corresponding
scales of the two forms were high, including those for the Conflict and
Social Desirability Scales. Internal reliability as measured by coefficient
alpha was also high for each scale. A copy of the scales is included in Table
A.3.
To provide a measure of the discriminant validity of the Personality
Profile, three groups were compared: 74 nonpatients, 144 psychiatric out-
patients, and 60 psychiatric inpatients at a large municipal hospital. Anal-
ysis of variance showed that the outpatients scored highest of all groups
on the scales of Submissive, Passive, Depressed, Rejecting, and Conflict.
The inpatients were significantly less aggressive, sociable, and conflicted
than either the nonpatients or the outpatients. Only on the Assertiveness
Scale did the nonpatients score higher than the inpatients or the outpa-
tients. These findings make clinical sense.
Another study using the Personality Profile, Form B was concerned
APPENDIX 179
TABLE A.3
Personality Profile (Form B)
5. I get jealous
r i ~ ~ ~
8. I am kind
180 APPENDIX
TABLE A.3 (Continued)
t
Some- very
Never Rarely times Often Often
21. Its difficult to get me to change
my mind
22. I get into fights with other people
29. I am selfish
APPENDIX 181
TABLE A.3 (Continued)
~~~ ~
182 APPENDIX
TABLE A.3 (Continued)
-F
Some-
Never Rarely times Often Often
~~
people from carrying out their
plans
71. I show my true feelings and
opinions
~
1
excited
76. I am unhappy I I I
77. I dont accept new ideas or
people easily
83. I am grumpy I I I
84. I get excited about many things
85. I dont get upset easily
APPENDIX 183
with the extent to which personality traits can be used to predict the
outcome of psychotherapy (Conte, Plutchik, Buck, Picard, & Karasu,
1991). In this study, 96 patients who were newly admitted to a psychiatric
outpatient clinic attended a median of 14 therapy sessions and completed
the Personality Profile, Form B after registering at the clinic and prior to
their psychiatric evaluations. Only the dimension of rejection was found
to be negatively correlated with the outcome measures. However, there was
a significant positive correlation between scores on the dimensions of Re-
jection, Aggression, Conflict, and Passivity and the number and extent of
symptoms and problems with which these patients presented at the out-
patient clinic.
A second study (Conte, Plutchik, Buck, Picard, & Karasu, 1991) in-
vestigated the relations between ego functions and personality traits. Four
ego function scales-Judgment, Synthetic-Integrative Functioning,
Mastery-Competence, and Ego Strength Scales-were used based on Bel-
laps (1984) descriptions of ego functions. Correlations between these var-
ious dimensions and the eight personality dimensions were obtained. Gen-
erally the dimensions of submissive, passive, depressed, rejecting, aggressive,
and conflict all correlated negatively and significantly with the four ego
functions. Acceptance, assertiveness, and sociability all correlated posi-
tively with the ego functions. The highest correlation that was found (.68)
was between assertiveness and ego strength. It thus appears that ego func-
tions, as conceptualized within a psychodynamic tradition, correlated
highly with personality dimensions.
Conte, Plutchik, Picard, Galanter, and Jacoby (1991) provide an ex-
ample of the use of the Personality Profile, Form B to study personality
traits and coping styles of hospitalized alcoholic individuals. In this study,
40 inpatients on an alcohol detoxification unit of a large municipal hospital
were administered a battery of tests consisting of the Personality Profile,
Form B a coping styles test; a Depression Scale; and the Brief MAST, a
measure of alcohol-related behavior (Vaillant, 1983). A demographically
comparable group of 40 outpatients attending the medical screening clinic
of the same hospital also completed the battery.
Results showed that those in the alcoholic group as a whole described
themselves as considerably more passive, conflicted, and depressed. Alco-
holic women scored significantly higher than the alcoholic men on the
dimensions of passivity, aggressiveness, depression, and conflict. Alcoholic
women were also more submissive, passive, and depressed than the non-
alcoholic women in the comparison group. Overall, the results suggest that
hospitalized alcoholic women were considerably more dysfunctional than
either nonalcoholic women or alcoholic men. These differences may be
seen in the Personality Profile, Form B scoring circumplex shown in Figure
A.2.
184 APPENDIX
PERSONALITY PROFILE INDEX
Figure A.2. Comparison of Personality Profile Index Dimensions of Alcoholic (left: n = 17) and Nonalcoholic (right; n = 23) Women.
From Sex Differences in PersonalityTraits and Coping Styles of Hospitalized Alcoholics, by H. R. Conte, R. Plutchik, S. Picard, M.
Galanter, and J. Jacoby, 1991, Journal of Studies on Alcohol, 52, p. 30. Copyright 1991 by Journal of Studies on Alcohol. Reprinted
with permission.
03
ul
THE MEASUREMENT OF EGO DEFENSES
(THE LIFE STYLE INDEX)
186 APPENDIX
TABLE A.4
Life Style Index
17. I believe its better to think things out than to get angry
APPENDIX 187
TABLE A.4 (Continued)
1 Yes I NO
23. I hate hostile people
I
30. When I go on a trip, I plan every detail in advance I /
31. Sometimes I wish that an atom bomb would destroy the world I I
32. Pornography is disgusting I I
33. When I become upset I eat a lot I 1
34. I never feel fed up with people
35. I cannot remember many things about my childhood
77. I think the world situation is much better than most people think
it is
78. When I am disappointed, I act very moody
formation and regression than are normal elderly men. The women also
report experiencing a greater number of life problems. Life problems and
total ego defense score correlated highly.
Another study (Greenwald, Reznikoff, & Plutchik, 1994) correlated
190 APPENDIX
EXHIBIT A . l
Items Ranking Highest on Relevancy for the Eight Ego Defense Scales
Compensation
In my dreams, Im always the center of attention.
Denial
I am free of prejudice.
Displacement
If someone bothers me, I dont tell it to him, but I tend to complain to
someone else.
Intellectualization
I am more comfortable discussing my thoughts than my feelings.
Projection
I believe people will take advantage of you if you are not careful.
Reaction Formation
Pornography is disgusting.
Regression
I get irritable when I dont get attention.
Repression
I rarely remember my dreams.
Life Style Index scores with personality disorder diagnoses obtained from
the Millon Clinical Multiaxial Inventory (Millon, 1987). The population
consisted of a group of 74 hospitalized alcoholic individuals. It was found
that each personality disorder diagnosis correlated highest with a particular
ego defense (for six of the eight scales) in such a way as to be consistent
with the theory of defenses as derivatives of emotion (described in chapter
6). For example, histrionic personality disorder correlated highest with de-
nial, whereas paranoid personality disorder correlated highest with projec-
tion (Greenwald, Reznikoff, & Plutchik, 1994).
In recent years, the Life Style Index has been translated into Dutch,
Norwegian, Russian, Hebrew, and Chinese. One of the studies from Israel
may be used to illustrate what the scoring profiles look like. A total of 130
adolescent patients at a psychiatric hospital in Israel were tested with the
Life Style Index and several other scales. Forty of the 130 patients had
been admitted subsequent to a suicide attempt. Comparable data were ob-
tained from a group of nonsuicidal high school students (control group).
Results showed that the suicidal patients scored significantly higher than
the control group on repression, regression, and total defense score. The
pattern of results for the suicidal patients is presented in Figure A.3.
When the suicidal patients were compared with the nonsuicidal in-
patients, it was found that the suicidal patients had the highest ego defense
scores, the nonsuicidal inpatients had intermediate defense scores, and the
control group had the lowest ego defense scores. It appears that the patients
admitted for a suicide attempt were more disturbed and in greater conflict
than the other two groups.
Figure A.3 shows that the suicidal patients are considerably above the
APPENDlX 191
Figure A.3. Percentile Scores on the Life Style Index of 40 Suicidal
Adolescents. From The Life Style Index: A Self-Report Measure of Ego
Defenses (p. 195), by H. R. Conte and A. Apter, 1995. In 90 Defenses:
Theory and Measurement, edited by H. R. Conte and R. Plutchik. Copyright
1995 by John Wiley & Sons. Reprinted with permission.
I92 APPENDJX
scores on regression implies that they are impulsive, moody, and act child-
ishly when frustrated. These scale scores thus provide a picture of conflicted
young people who described themselves as high-minded and mature and
at the same time, angry and childish.
The Life Style Index appears to be a reasonable way to measure the
conscious derivatives of unconscious defense mechanisms. It is easy to ad-
minister and score and has revealed some interesting relations between ego
defenses and anxiety, self-esteem, alcoholism, suicidality, violence, and
other clinical variables. It is based on theory and is part of the family of
scales implied by affect theory.
APPENDlX 193
placement (compensation), and help-seeking (regression). These concepts
have been defined in chapter 6.
A group of five clinicians met regularly to construct items that re-
flected the many ways that people use to cope with problems. It became
increasingly evident that the coping methods could be grouped into a rel-
atively few categories. The schema proposed here of eight basic coping
styles that correspond to eight basic ego defenses seemed to be both general
and parsimonious.
After consensus had been arrived at among the members of the group,
the items were then presented to an independent group of 10 psychiatrists,
who were asked to indicate the extent to which each item adequately
reflected each of the eight basic coping styles as defined by the theoretical
model. On the basis of their responses, several items were dropped and the
wording of others was changed.
The 95 items of the scales, labeled the AECOM Coping Scale, were
incorporated into a format in which the respondent indicated on a 4-point
scale how frequently he or she felt or acted in the ways described (see
Table AS). For example, the coping style of minimization is reflected by
such items as When something bothers me, I can ignore it and I feel
that problems have a way of taking care of themselves. Suppression is
expressed by such items as I try not to think about unpleasant things
and I avoid funerals. Help-seeking is defined by such items as When I
have a problem I try to get others to help me and I try to be associated
with people who take charge of a situation.
The AECOM Coping Scales have been administered to several non-
patient and patient groups and has been modified so that the present ver-
sion contains 87 items. Preliminary norms from a sample of 120 college
students are available. No sex differences have been found in coping styles
in this college population. The internal reliabilities of the eight coping
scales as measured by coefficient alpha varied from .58 to .79, with an
average of .70. The use of the scales as a teaching device in a series of
workshops on professional burnout is described by Wilder and Plutchik
(1982).
In an unpublished study (Plutchik & Lang, 1990), 199 prisoners in a
Canadian penitentiary were asked to complete the AECOM Coping Scales
along with several other instruments. A group of 76 Canadian college
students also completed the same battery of tests. It was found that the
college students scored significantly higher than the prisoners on the cop-
ing styles of minimization, replacement, and reversal and scored signifi-
cantly lower on suppression, help-seeking, and mapping. When these cop-
ing styles of the prisoners were correlated with parenting styles of their
parents, it was found that high maternal rejection and depression were
associated with the tendency of the prisoners to use help-seeking as a cop-
ing style for solving problems. The fathers degree of sociability was found
194 APPENDIX
TABLE A.5
AECOM Coping Scales
Some-
Never Rarely times Often
1. Im an optimist
APPENDIX 195
TABLE A.5 (Continued)
Never
196 APPENDIX
TABLE A.5 (Continued)
I
Never Rarely /Some-l
times Often
APPENDIX 197
TABLE A.5 (Continued)
-I
56. When something bothers me, I can
ignore it
57. I avoid visiting a person who is in
mourning
T
58. I ask other people for their advice when I
am not sure about something
59. When I feel unhappy, I try to do
something that will cheer me up
60. If others were kinder to me, I could get
more done
61. When Im upset, reading calms me
down
62. When I have many decisions to make, I
decide which is most important before I
do anything
63. When Im in an ernbarrasing situation, I
try to act as if I am comfortable
~~ ~~~
APPENDIX 199
defense of denial and the coping style of blame than were those managers
who had few psychological symptoms. They were also judged to be less
effective managers. Managers evaluated as effective copers had relatively
high scores on mapping. When the managers rated low on stress were
compared to those rated high, it was found that the low-stress individuals
were relatively lower on most of the coping styles, with the exception of
suppression and mapping, whereas the high-stress individuals were high on
everything except reversal and help-seeking. These patterns indicate that
the presence of psychological symptoms and level of functioning on the
job are related to patterns of coping.
Another study (Conte, Plutchik, Picard, Galanter, & Jacoby, 1991)
compared 40 alcoholic inpatients on a detoxification ward with 40 control
patients with the same general social background but who came to an
emergency room screening clinic for treatment of minor physical ailments.
All patients took a battery of tests that included the coping scales.
Figure A.4 shows the coping style profile of the 40 alcoholic inpa-
tients. They appeared to have a strong tendency to use suppression as a
way of dealing with life stresses. They also were very likely to blame other
people for their problems, and they had a strong tendency to seek help
from others. (Perhaps this tendency is the basis for describing alcoholic
individuals as dependent personalities.) The alcoholic individuals were sig-
nificantly higher on these coping dimensions than those in the matched
control group.
Conte, Plutchik, Schwartz, and Wild (1983) used the AECOM Cop-
ing Scales in an effort to predict change in hospitalized individuals with
schizophrenia after discharge. In this investigation, a group of inpatients
with schizophrenia completed a battery of self-report questionnaires de-
signed to measure dimensions of personality, affect, conflict, ego defenses,
and coping styles. Similar ratings were made by each patients primary
therapist. Those patients who were rehospitalized during the next 2 years
were identified. It was found that the best predictors of readmission to the
hospital included two ego defenses, denial and displacement, and the cop-
ing style of suppression. This latter finding is consistent with the prisoner
study in which the prisoners were also found to use suppression significantly
more than did the control group.
Joseph0 and Plutchik (1994) investigated the relations between in-
terpersonal problems, coping styles, and suicide risk. The study sample con-
sisted of 71 adult psychiatric inpatients from a large municipal hospital.
One-fourth of the patients (25%) were admitted because of a suicide at-
tempt, and approximately two-fifths (40%) of the patients had suicidal
ideation included as a reason for admission.
Each patient was asked to complete a suicide risk scale, a problem
checklist, and the AECOM Coping Scales. Results showed that the num-
ber of interpersonal problems was significantly and positively related to
200 APPENDIX
Figure A.4. Coping Profile of a Group of 40 HospitalizedAlcoholics Based on
Sex Differences in Personality Traits and Coping Styles of Hospitalized
Alcoholics. From Sex Differences in Personality Traits and Coping Styles of
HospitalizedAlcoholics, by H. R. Conte, R. Plutchik, S. Picard, M. Galanter,
and J. Jacoby, 1991, Journal of Studies on Alcohol, 52, p. 29. Copyright 1991
by the Journal of Studies on Alcohol. Reprinted with permission.
suicide risk. Those who attempted suicide had significantly more problems
than the comparison groups (i.e.l those patients who had suicidal ideation
only, and those with no suicidal symptoms) and were significantly higher
on the coping style of suppression. They were also significantly lower on
the coping styles of replacement (i.e., improving limitations that exist in
oneself or in the situation). In addition, partial correlation analyses indi-
cated that the greater the tendency to minimize (i.e., assuming the problem
is not as important as other people think it is), the lower the suicide risk.
When the coping measures as a group were added to the problem stress
measure, a large improvement in the prediction of suicide risk was ob-
tained.
APPENDIX 201
SUMMARY
This appendix has described a number of tests and scales that may
be used to measure moods, emotions, personality traits, ego defenses, and
coping styles. The scales included here are all based on the psychoevolu-
tionary theory of affect in the sense that the basic dimensions to be mea-
sured are all basic emotions or derivatives of the eight basic emotions. All
the scales also use the circumplex model. The most adequate measures are
those derived from theory so that the outcome of the measurement oper-
ations may contribute to the enhancement or modification of the theory.
Theory-based measures also have a wider nomological network than do
purely empirical measures. For each test described in this chapter, some
empirical data are given to show the usefulness of these instruments in
clinical settings. The diversity of measuring instruments implies that the
measurement of emotions is a much broader problem than is the measure-
ment of subjective feelings by means of adjective checklists (Plutchik &
Conte, 198910; Plutchik & Van Praag, 1998). The field of emotion study
comprises a vast array of phenomena, and the ideal measures of emotion
and its derivatives are those that are diverse, theory-based, and systemat-
ically related to these complex phenomena.
202 APPENDIX
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AUTHOR INDEX
Ahola, T., 33 Conte, H. R., 9, 62, 70, 82, 87, 90, 91,
Akhtar, S., 94 96, 97, 115, 157, 158, 159, 160,
Alexander, R. D., 109 163, 177, 178, 179, 184, 185,
Allen, B., 63 186, 192, 200, 202
American Psychiatric Association, 4, 21, Corruble, E., 84
23, 82, 84, 87, 88, 94, 112 Cosmides, L., 60
American Thesaurus of Slang, 13, 14
Apter, A., 9, 186, 192
Arieti, S., 113, 116 Darwin, C., 5, 41, 42, 74
Averill, J. R., 40 Davies, N. B., 150
Davitz, J. R., 129
Del Pono, 1. A., 84
DiClemente, C. C., 36, 37
Baer, B. A., 101 Dictionary of American Slang, 13
Barko, J. H., 60 DiScipio, W. S., 177
Becker, D. F., 86 Dix, T., 75
Beitman, B. D., 35 Douvan, E., 22
Bellak, L., 116, 184 Dryer, D. C., 102
Benjamin, L. S., 84, 90, 102, 155, 166 Dwyer, T. F., 112
Bibring, G. L., 112
Blashfield, R. K., 89
Bogdan, R. J., 67 Edell, W. S., 86
Bohmstedt, G. W., 71 Elliott, R., 16, 57
Bond, M., 112 Ellis, A., 17, 26
Brenner, C., 5, 48, 49, 50 English, 0. S., 113, 116
Breuer, J., 5, 41, 43, 44 Ewalt, J. R., 113
Buck, L., 184
Buirski, P., 140
Bull, N., 98 Fahs, H., 177
Bunker, K. A., 123, 199 Famsworth, D. L., 113
Bynner, J. M., 96 Fava, M., 85
Fehan, D. C., 86
Fenichel, O., 27, 45, 75, 113, 114, 116
Field, S., 22
Campbell, L., 96 Fieve, R. R., 173, 177
Cannon, W. B., 41, 42, 48, 67 Finch, S. M., 113, 116
Cantor, N., 76 Fine, B. D., 112
Carroll, J. M., 176 Fiorentino, D., 177
Carson, R. C., 87 Fisher, G. A., 71, 82
Chapman, A. H., 116 Fisher, S., 60
Cheney, D. L., 75 Foss, M. A., 40
Christian, J., 112 Frances, A., 87
Ciani, N., 86 Frankl, V. E., 22, 25
Clore, G. I., 40 Freud, A., 112
Coffey, H. S., 83 Freud, S., 5 , 41, 43, 44, 45, 46, 110, 111,
Collins, L., 177 114
21 7
Fridlund, A. J., 150 Jacoby, J., 9, 184, 185, 200
Fullerton, D. T., 177 James, W., 5 , 41, 42
Furman, B., 33 Jerrett, I., 178
Fyer, M. R., 87 Josepho, S. A., 9, 200
Mahoney, M. J., 26
Ihilevich, D., 114 Maranhao, T., 26, 27, 32, 155
Taurke, E., 54
Tomkins, S. S., 5, 19, 29, 53 Wachtel, P. L., 154, 165, 166
Tooby, J., 60 Wagner, C. C., 101
Tracey, T. J. G., 71 Wallace, C. J., 146
Trobst, K. K., 71 Websters International Unabridged
Troisi, A., 86 Dictionary, 15
Trower, P., 77 Weisman, A. D., 16, 25, 66, 108
Westen, D., 60, 61, 186
Whissell, C., 178
White, R. W., 116
Ureno, G., 101
Widiger, T., 85, 87
Wiggins, J. S., 71, 84, 89, 96
Wild, K., 200
Vaillant, G. E., 113, 115, 116, 184 Wilde, S., 157, 158, 159, 160, 163
Vaillant, L.M., 5, 16, 19, 25, 29, 49, 54, Wilder, J. S., 194
55, 70, 136, 137, 151 Williams, M. H., Jr., 178
Valenstein, A. F., 112 Wilson, E. O., 150
Vandenbs, G. R., 22
van Praag, H. M., 86, 147, 202
Verwoerdt, A., 113 Yalom, I., 23, 25, 28, 33, 35, 36, 37, 110,
Veroff, J., 22 138, 143, 144, 147
Veselica, K. C., 178 Young, P. T., 67
22 1
Circumplex model. See also Psychoevolu- Death anxiety, 143-144
tionary theory Deception, 107-126
axes question, 100-101 as clinical issue, 110
clinical practice application, 101-103 and evolutionary psychology, 108-1 10
ego defenses, 118-121 facial expression in, 108
emotion derivatives, 70-73 Freudian theory, 110
and emotion sequence, 64-70 self-deception association, 109
impulses to action, 97-100, 104-106 Defense mechanisms. See Ego defenses
personality disorders, 86-97 Denial (defense mechanism)
Personality Profile test, 178-179 circumplex model, 118-121
personality traits, 70-71 corresponding coping style, 122
in structural model, 62-64 death anxiety reaction, 143
Client-centered therapy, 17-18 Life Style Index assessment, 191-192
Clients, 17-18 underlying structure, 119
Cognitive appraisal, 35 Dependent personality disorder
Cognitive-behavior therapy, 159- 160 circumplex model, 91-97
Cognitive coping, 56 DSM-IV affect disturbances, 24
Cognitive theory, 16, 41, 43 as emotion derivative, 83
Collaborative therapeutic relationship, personality traits link, 85
166-167 Depression
Color relationships, emotions similarity, adjective checklists, 172-174
62-63 and Brenners ego psychology, 49-51
Communication, 149-151. See also Ther- Emotions Profile Index, 177-178
apeut ic communication function of, 76-77
Comorbidity, personality disorders, 84-87 grief differences, 142-143
Compensation (defense mechanism) and hierarchical relationships, 140
circumplex model, 118-120 therapeutic tactics, 134-135
corresponding coping style, 122 Derivatives model, 70-73
Life Style Index assessment, 191-192 and coping styles, 193
underlying structure, 119 ego defenses, 117-118
Complementarity theory, 101 and personality, 70-73
Conflict in psychoevolutionary theory, 70-73
emotional components, 129
Dickinson, Emily, 13
and impulse to action, 98
Digital coding, of speech, 150
Control relationships
Disgust (basic emotion)
existential issues, 140-141
circumplex model, 64
symptoms link, 30
derivatives, 73, 83
and territoriality, 141
personality disorders link, 83
Coping response, Lazaruss theory, 55-57
sequential model, 69
Coping styles, 107-126
characteristics, 121-126 Disidentification, 144
ego defenses relationship, 115, 121- Displacement (defense mechanism)
125 circumplex model, 118-121
measurement scale, 9-10 corresponding coping style, 122
therapeutic tactics, 132-133 Life Style Index assessment, 191-192
Core conflicts, 135 underlying structure, 119
Core relational theme, 56 Dominance hierarchies, 140-141
Drives
affects link, 52-54
Darwinian theory, 41-42, 60 and symptoms, 27
229